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Vasella M, Wolf S, Grünherz L, Kim BS, Lindenblatt N, Giovanoli P, Gousopoulos E. Evaluation of the Effect of Botulinum Toxin A on the Lymphatic Endothelial Cells. Aesthetic Plast Surg 2024:10.1007/s00266-024-04061-7. [PMID: 38839615 DOI: 10.1007/s00266-024-04061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/09/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Botulinum toxin A (BoTA) is a neurotoxin formed by Clostridium botulinum, with a broad medical application spectrum. While the primary effect of BoTA is on the muscles, the effects of BoTA in other systems including the blood vasculature have already been examined, revealing unexpected actions. However, no studies exist to the best of our knowledge regarding the potential effects of BoTA on the lymphatic vascular system, possessing a critical role in health and disease. Isolated human lymphatic endothelial cells (LECs) were cultured in dedicated in vitro culture systems. The analysis including imaging and cell culture approaches as well as molecular biology techniques is performed to examine the LEC alterations occurring upon exposure to different concentrations of BoTA. MATERIALS AND METHODS Human LECs were cultured and expanded on collagen-coated petri dishes using endothelial basal medium and the commercial product Botox from Allergan as used for all our experiments. Harvested cells were used in various in vitro functional tests to assess the morphologic and functional properties of the BoTA-treated LECs. Gene expression analysis was performed to assess the most important lymphatic system-related genes and pathways. RESULTS Concentrations of 1, 5 or 10 U of BoTA did not demonstrate a significant effect regarding the proliferation and migration capacity of the LECs versus untreated controls. Interestingly, even the smallest BoTA dose was found to significantly decrease the cord-like-structure formation capacity of the seeded LECs. Gene expression analysis was used to underpin possible molecular alterations, suggesting no significant effect of BoTA in the modification of gene expression versus the starvation medium control. CONCLUSION LECs appear largely unaffected to BoTA treatment, with an isolated effect on the cord-like-structure formation capacity. Further work needs to assess the effect of BoTA on the smooth-muscle-cell-covered collecting lymphatic vessels and the possible aesthetic implications of such an effect, due to edema formation. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mauro Vasella
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Stefan Wolf
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Lisanne Grünherz
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Nicole Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Epameinondas Gousopoulos
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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Leroi AM, Queralto M, Zerbib F, Siproudhis L, Vitton V, Amarenco G, Etienney I, Mion F, Bridoux V, Philip J, Brochard C, Damon H, Lacroix E, Gillibert A, Gourcerol G. Intrarectal injections of botulinum toxin versus placebo for the treatment of urge faecal incontinence in adults (FI-Toxin): a double-blind, multicentre, randomised, controlled phase 3 study. Lancet Gastroenterol Hepatol 2024; 9:147-158. [PMID: 38128556 DOI: 10.1016/s2468-1253(23)00332-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Non-randomised studies assessing intrarectal botulinum toxin type A (BoNTA) injections for faecal incontinence are promising. We aimed to evaluate the efficacy of BoNTA for the treatment of faecal incontinence in a randomised study. METHODS In this randomised, double-blind, placebo-controlled study, we included adult patients who had at least one urgency or faecal incontinence episode per week for at least 3 months and who had experienced a failure of conservative or surgical treatment from eight French specialist hospital units with the skills to manage patients with faecal incontinence. Patients were randomly assigned (1:1) by a central web form to receive intrarectal submucosal injections of either 200 units of BoNTA (Botox; Allergan, Irvine, CA, USA; BoNTA group) or an equivalent volume of saline (placebo group), stratified by Cleveland Clinic Severity scores (CCS score; ≥12 or <12). Patients, investigators, study site staff, and sponsor personnel were masked to treatment allocation up to the 6-month visit. The primary endpoint was the number of episodes of faecal incontinence and urgency per day assessed using 21-day patient bowel diaries 3 months after the treatment. The primary analysis was performed using a modified intention-to-treat (mITT) approach (ie, in all the randomised patients who had received a treatment) with adjustment for baseline faecal incontinence and urgency episodes. After the final data collection at 6 months after injections, patients were unmasked and offered the BoNTA treatment if they were in the placebo group (rescue therapy) without masking, with an additional 6 months of safety follow-up. This trial is registered with ClinicalTrials.gov, number NCT02414425. FINDINGS Between Nov 25, 2015, and Nov 25, 2020, we randomly assigned 200 patients to receive either BoNTA (n=100) or placebo (n=100) injections. Due to withdrawals before the injections, 96 patients were included in the BoNTA group and 95 patients were included in the placebo group (mITT analysis). The mean number of faecal incontinence and urgency episodes per day in the BoNTA group decreased from 1·9 (SD 2·2) at baseline to 0·8 (1·8) at 3 months after the injections, and from 1·4 (1·1) to 1·0 (1·0) in the placebo group, with a baseline-adjusted mean group difference at 3 months estimated at -0·51 (95% CI -0·80 to -0·21, p=0·0008). No serious treatment-related adverse events were reported in the trial. The most frequently reported non-serious adverse event (treatment related or not) following the BoNTA or placebo injections was constipation (reported in 68 [40%] of 169 patients who received the BoNTA injections and 38 [40%] of 95 patients who received placebo injections). INTERPRETATION BoNTA injections are an efficacious treatment for urge faecal incontinence. Further research will define the optimum selection criteria, dose, site of injection, re-injection frequency, and long-term results. FUNDING General Direction of Healthcare (French Ministry of Health).
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Affiliation(s)
- Anne-Marie Leroi
- Université de Rouen Normandie, Institut National de la Santé et de la Recherche Médicale (INSERM), ADEN UMR1073, Centre Hospitalier Universitaire (CHU) Rouen, Centre d'Investigation Clinique-Centre de Ressources Biologiques (CIC-CRB) 1404, Department of Digestive Physiology, Rouen, France.
| | - Michel Queralto
- Colproctology Unit, Clinique des Cèdres, Cornebarrieu, France
| | - Frank Zerbib
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Levêque, Department of Gastroenterology, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Laurent Siproudhis
- Department of Gastroenterology, Inphy CIC1414, CHU Rennes, Université de Rennes 1, Rennes, France
| | - Véronique Vitton
- Department of Gastroenterology, Hôpital Nord, Assistance-Publique Hôpitaux de Marseille, Aix-Marseille Université, France
| | - Gérard Amarenco
- Sorbonne Université, Groupe de Recherche Clinique (GRC) 001, GREEN GRC en Neuro-Urologie, Assistance Publique - Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Isabelle Etienney
- Department of Coloproctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Francois Mion
- Université de Lyon, Department of Digestive Physiology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Valerie Bridoux
- Université de Rouen Normandie, INSERM, ADEN UMR1073, CHU Rouen, Department of Digestive Surgery, Rouen, France
| | - Julie Philip
- Colproctology Unit, Clinique des Cèdres, Cornebarrieu, France
| | - Charlène Brochard
- Diseases of the Digestive Tract Department, Functional Digestive Explorations Division, Centre Hospitalier Régional Universitaire Pontchaillou, CIC1414, Université de Rennes 1, Rennes, France; INSERM U1235, Université de Nantes, Nantes, France
| | - Henri Damon
- Université de Lyon, Department of Digestive Physiology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Elie Lacroix
- Department of Biostatistics, CHU Rouen, Rouen, France
| | | | - Guillaume Gourcerol
- Université de Rouen Normandie, Institut National de la Santé et de la Recherche Médicale (INSERM), ADEN UMR1073, Centre Hospitalier Universitaire (CHU) Rouen, Centre d'Investigation Clinique-Centre de Ressources Biologiques (CIC-CRB) 1404, Department of Digestive Physiology, Rouen, France
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Yunfeng G, Fei L, Junbo L, Dingyuan Y, Chaoyou H. An indirect comparison meta-analysis of noninvasive intravesical instillation and intravesical injection of botulinum toxin-A in bladder disorders. Int Urol Nephrol 2022; 54:479-491. [PMID: 35044552 DOI: 10.1007/s11255-022-03107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) intravesical instillation and BTX-A intravesical injection are both effective treatments or overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS), but direct comparative studies of the two treatments are lacking. METHODS We conducted a pairs-comparison meta-analysis and an adjusted indirect comparison meta-analysis extracting published data from randomized controlled trials in literature databases from the inception of each database to Aug. 31, 2021, evaluating efficacy and safety of BTX-A intravesical instillation and BTX-A intravesical injection. We also carried out a subgroup analysis. RESULTS We identified 24 trials in 21 studies were included in our study, of which 18 trials in 17 studies were BTX-A intravesical injections, 6 trials in 4 studies were BTX-A intravesical instillation. Compared with the normal saline injection, BTX-A intravesical injections for patients with OAB and IC/ BPS can obviously improve the symptoms of urinary frequency, urgency episode, UI and UUI, but BTX-A significantly increased the rate of urinary retention and urinary tract infection and increased PVR (p < 0.05). Adjusted indirect comparison meta-analysis showed that BTX-A intravesical injections was more effective than BTX-A intravesical instillation (p > 0.05). Surprisingly, BTX-A intravesical instillation had fewer side effects than BTX-A intravesical injections (p < 0.05). CONCLUSIONS Although BTX-A intravesical injections of OAB and IC/BPS has been significantly superior the BTX-A intravesical instillation, it has major side effects, but this needs to be confirmed by more large-scale, multicenter, direct comparison randomized controlled trials.
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Affiliation(s)
- Gao Yunfeng
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Lai Fei
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Liu Junbo
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Yang Dingyuan
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Huang Chaoyou
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China.
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Svensson E, Zvara P, Qvist N, Hagander L, Möller S, Rasmussen L, Schrøder HD, Hejbøl EK, Bjørn N, Petersen S, Larsen KC, Krhut J, Muensterer OJ, Ellebæk MB. The Effect of Botulinum Toxin Type A Injections on Stricture Formation, Leakage Rates, Esophageal Elongation, and Anastomotic Healing Following Primary Anastomosis in a Long- and Short-Gap Esophageal Atresia Model - A Protocol for a Randomized, Controlled, Blinded Trial in Pigs. Int J Surg Protoc 2021; 25:171-177. [PMID: 34435166 PMCID: PMC8362621 DOI: 10.29337/ijsp.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Esophageal atresia (EA) is a congenital malformation affecting 1:3000-4500 newborns. Approximately 15% have a long-gap EA (LGEA), in which case a primary anastomosis is often impossible to achieve. To create continuity of the esophagus patients instead have to undergo lengthening procedures or organ interpositions; methods associated with high morbidity and poor functional outcomes. Esophageal injections of Botulinum Toxin Type A (BTX-A) could enable primary anastomosis and mitigate stricture formation through decreased tissue tension. METHODS AND ANALYSIS In this randomized controlled blinded animal trial, 24 pigs are divided into a long- or short-gap EA group (LGEA and SGEA, respectively) and randomized to receive BTX-A or isotonic saline injections. In the LGEA group, injections are given endoscopically in the esophageal musculature. After seven days, a 3 cm esophageal resection and primary anastomosis is performed. In the SGEA group, a 1 cm esophageal resection and primary anastomosis is performed, followed by intraoperative injections of BTX-A or isotonic saline. After 14 days, stricture formation, presence of leakage, and esophageal compliance is assessed using endoscopic and manometric techniques, and in vivo and ex vivo contrast radiography. Tissue elongation is evaluated in a stretch-tension test, and the esophagus is assessed histologically to evaluate anastomotic healing. ETHICS AND DISSEMINATION The study complies with the ARRIVE guidelines for animal studies and has been approved by the Danish Animal Experimentation Council. Results will be published in peer-reviewed journals and presented at national and international conferences. HIGHLIGHTS The optimal management of long-gap esophageal atresia remains controversialPrimary anastomosis could improve functional outcomes and reduce complicationsBotulinum Toxin Type A decreases tissue tension and could facilitate anastomosisReduced tension could further abate the risk for anastomotic stricture and leakageWe present a model to evaluate the method in long- and short-gap esophageal atresia.
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Affiliation(s)
- Emma Svensson
- Pediatric surgery, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University. Skane University Hospital Lund, 221 84 Lund, Sweden
| | - Peter Zvara
- Research Unit for Urology, Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Lars Hagander
- Pediatric surgery, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University. Skane University Hospital Lund, 221 84 Lund, Sweden
| | - Sören Möller
- OPEN – Open Patient data Explorative Network, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000 Odense C, Denmark
| | - Lars Rasmussen
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Henrik Daa Schrøder
- Department of Pathology, Odense University Hospital, University of Southern Denmark, J.B. Winsløws Vej 15, 5000 Odense, Denmark
| | - Eva Kildall Hejbøl
- Department of Pathology, Odense University Hospital, University of Southern Denmark, J.B. Winsløws Vej 15, 5000 Odense, Denmark
| | - Niels Bjørn
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Súsanna Petersen
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Kristine Cederstrøm Larsen
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jan Krhut
- Department of Surgical Studies, Medical Faculty, Ostrava University, Syllabova 19, 703 00, Ostrava, Czech Republic
- Department of Urology, University Hospital, 17.listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Oliver J. Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital of the Ludwig-Maximilians-University Munich, Lindwurmstraße 4, 80337 Munich, Germany
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
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Use of onabotulinum toxin A in patients with idiopathic overactive bladder and a lack of efficacy, intolerance or contraindication with anticholinergics. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the efficacy and safety of onabotulinum toxin A in patients with idiopathic overactive bladder inadequately managed with anticholinergics.Materials and Methods A prospective, open-label, single centre, and interventional study was conducted, from 2008 to 2013, on consecutive patients with idiophatic overactive bladder that showed lack of efficacy or intolerance to anticholinergic agents.Results The study included 73 female patients aged 58.9 ± 12.9 years. A dose of 100 and 200 units of toxin were administered in 89 and 5 cases, respectively. Nineteen patients received a second injection, 8 patients received 3, and one patient was treated 4 times. Clinically, it was observed that 98% patients had urge urinary incontinence at baseline, as compared with 42% under treatment. Similar results were obtained regarding the number of pads used per day, from 2.8 at baseline to 0.5 after treatment as regards the urodynamic parameters, the first desire to void volume improved from 97 ± 63 mL to 139 ± 81 mL. Similar results were obtained as regards cystometric capacity and the volume of the first involuntary detrusor contraction. One patient had a positive urine culture resolved using a conventional oral antibiotic regimen. Intermittent catheterisation was required in 5 patients during the first week.Conclusions Onabotulinum toxin A injections significantly improved, not only the clinical symptoms, but also the urodynamic parameters in patients with idiopathic overactive bladder inadequately managed with anticholinergic drugs. This is a simple technique with minimal adverse effects and generally well tolerated.
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Joussain C, Popoff M, Phé V, Even A, Bosset PO, Pottier S, Falcou L, Levy J, Vaugier I, Chartier Kastler E, Schurch B, Denys P. Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity. Neurourol Urodyn 2017; 37:799-806. [DOI: 10.1002/nau.23352] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/10/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Charles Joussain
- Medical School Paris Île-de-France Ouest, Inserm U1179; Versailles Saint-Quentin University; Versailles France
| | - Mélanie Popoff
- Department of Physical Medicine and Rehabilitation; Hôpital Raymond-Poincaré AP-HP; Garches France
| | - Véronique Phé
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation; Hôpital Raymond-Poincaré AP-HP; Garches France
| | | | | | - Laetitia Falcou
- Department of Physical Medicine and Rehabilitation; Hôpital Raymond-Poincaré AP-HP; Garches France
| | - Jonathan Levy
- Department of Physical Medicine and Rehabilitation; Hôpital Raymond-Poincaré AP-HP; Garches France
| | | | - Emmanuel Chartier Kastler
- Department of Urology; Pitié-Salpêtrière Academic Hospital; Assistance Publique-Hôpitaux de Paris; Pierre and Marie Curie Medical School; Paris France
| | - Brigitte Schurch
- Department of Clinical Neuroscience; Neuropsychology and Neurorehabilitation Service; Lausanne University Hospital; Lausanne Switzerland
| | - Pierre Denys
- Medical School Paris Île-de-France Ouest, Inserm U1179; Versailles Saint-Quentin University; Versailles France
- Department of Physical Medicine and Rehabilitation; Hôpital Raymond-Poincaré AP-HP; Garches France
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Carlson K, Civitarese A, Baverstock R. OnabotulinumtoxinA for the treatment of idiopathic overactive bladder is effective and safe for repeated use. Can Urol Assoc J 2017; 11:E179-E183. [PMID: 28503231 DOI: 10.5489/cuaj.4194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this study was to compare efficacy and safety outcomes between patients receiving onabotulinum-toxinA (OnabotA) for the first time and those receiving a repeat injection. METHODS Data collected before and after OnabotA injection were extracted from a clinical registry. Patients were classified into either first or repeat injection subgroups. Efficacy was measured by the change in use of oral bladder medications, the number of voids per day or night, the frequency of urinary incontinence (UI) episodes, and patient-reported outcomes. Safety was measured by the number of self-reported complications. Differences in safety measures between the subgroups were tested. RESULTS The analysis included complete data from 81 patients; 30 (37%) receiving OnabotA for the first time, 51 (63%) receiving a repeat injection. Both subgroups reported significant reductions in the use of anticholinergics, more tolerable bladder symptoms, and improvements in patient-reported outcomes. Dry rates were similarly high in both groups (50% and 43%, respectively). There were no statistically significant differences between the subgroups in terms of their safety outcomes. CONCLUSIONS OnabotA is equally as efficacious and safe for patients with overactive bladder receiving a repeat injection as it is for those receiving their first injection.
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Affiliation(s)
- Kevin Carlson
- vesia [Alberta Bladder Centre], University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Civitarese
- vesia [Alberta Bladder Centre], University of Calgary, Calgary, AB, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre], University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Richter HE, Amundsen CL, Erickson SW, Jelovsek JE, Komesu Y, Chermansky C, Harvie HS, Albo M, Myers D, Gregory WT, Wallace D. Characteristics Associated with Treatment Response and Satisfaction in Women Undergoing OnabotulinumtoxinA and Sacral Neuromodulation for Refractory Urgency Urinary Incontinence. J Urol 2017; 198:890-896. [PMID: 28501541 DOI: 10.1016/j.juro.2017.04.103] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE We sought to identify clinical and demographic characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation therapies. MATERIALS AND METHODS We analyzed data from the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation versus BoTulinum Toxin Assessment) trial. Baseline participant characteristics and clinical variables were associated with 2 definitions of treatment response, including 1) a reduction in mean daily urgency incontinence episodes during 6 months and 2) a 50% or greater decrease in urgency incontinence episodes across 6 months. The OAB-S (Overactive Bladder-Satisfaction) questionnaire was used to assess satisfaction. RESULTS A greater reduction in mean daily urgency incontinence episodes was associated with higher HUI-3 (Health Utility Index-3) scores in the onabotulinumtoxinA group and higher baseline incontinence episodes (each p <0.001) in the 2 groups. Increased age was associated with a lesser decrease in incontinence episodes in the 2 groups (p <0.001). Increasing body mass index (adjusted OR 0.82/5 points, 95% CI 0.70-0.96) was associated with reduced achievement of a 50% or greater decrease in incontinence episodes after each treatment. Greater age (adjusted OR 0.44/10 years, 95% CI 0.30-0.65) and a higher functional comorbidity index (adjusted OR 0.84/1 point, 95% CI 0.71-0.99) were associated with reduced achievement of a 50% or greater decrease in urgency incontinence episodes in the onabotulinumtoxinA group only (p <0.001 and 0.041, respectively). In the onabotulinumtoxinA group increased satisfaction was noted with higher HUI-3 score (p = 0.002) but there was less satisfaction with higher age (p = 0.001). CONCLUSIONS Older women with multiple comorbidities, and decreased functional and health related quality of life had decreased treatment response and satisfaction with onabotulinumtoxinA compared to sacral neuromodulation for refractory urgency incontinence.
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Affiliation(s)
| | | | - S W Erickson
- RTI International, Research Triangle Park, North Carolina
| | | | - Y Komesu
- University of New Mexico, Albuquerque, New Mexico
| | - C Chermansky
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh
| | - H S Harvie
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Albo
- University of California-San Diego, San Diego, California
| | - D Myers
- Brown University, Providence, Rhode Island
| | - W T Gregory
- Oregon Health and Science University, Portland, Oregon
| | - D Wallace
- RTI International, Research Triangle Park, North Carolina
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López Ramos H, Torres Castellanos L, Ponce Esparza I, Jaramillo A, Rodríguez A, Moreno Bencardino C. Management of Overactive Bladder With OnabotulinumtoxinA: Systematic Review and Meta-analysis. Urology 2017; 100:53-58. [DOI: 10.1016/j.urology.2016.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/10/2016] [Accepted: 10/18/2016] [Indexed: 02/01/2023]
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Abstract
Overactive bladder (OAB) is a condition affecting millions of individuals in the United States. Anticholinergics are the mainstay of treatment. Bladder botulinum toxin injections have shown an improvement in symptoms of OAB equivalent to anticholinergic therapy. Percutaneous tibial nerve stimulation can decrease symptoms of urinary frequency and urge incontinence. Sacral neuromodulation for refractory patients has been approved by the Food and Drug Administration for treatment of OAB, urge incontinence, and urinary retention. Few randomized, head-to-head comparisons of the different available alternatives exist; however, patients now have increasing options to manage their symptoms and improve their quality of life.
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Kuo YC, Kuo HC. Adverse Events of Intravesical OnabotulinumtoxinA Injection between Patients with Overactive Bladder and Interstitial Cystitis--Different Mechanisms of Action of Botox on Bladder Dysfunction? Toxins (Basel) 2016; 8:toxins8030075. [PMID: 26999201 PMCID: PMC4810220 DOI: 10.3390/toxins8030075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 11/27/2022] Open
Abstract
Intravesical onabotulinumtoxinA (BoNT-A) injections have been proposed to treat both overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) in patients with refractory conditions. We compared adverse events (AEs) after BoNT-A treatment between IC/BPS and OAB in women. IC/BPS patients who failed conventional treatments were enrolled to receive suburothelial injections of BoNT-A (100 U) followed by hydrodistention. Age matched OAB female patients refractory to antimuscarinic agents underwent BoNT-A (100 U) injections. The bladder capacity, maximum flow rate (Qmax), post-void residual (PVR), and voiding efficiency (VE) at baseline, 3 and 6 months, and the post-treatment AEs were analyzed between groups. Finally, 89 IC/BPS and 72 OAB women were included. In the OAB group, the bladder capacity and PVR increased, and VE decreased significantly at three and six months after BoNT-A treatment. In the IC/BPS group, the Qmax increased significantly at six months. There were significant differences in changes of capacity, Qmax, PVR and VE between the two groups. Moreover, OAB patients suffered more frequently from events of hematuria, UTI, and large PVR (>200 mL), but less frequently from events of straining to void. In conclusion, OAB women had higher PVR volume and lower VE than those in IC/BPS after BoNT-A injections. These results imply that the bladder contractility of OAB patients are more susceptible to BoNT-A, which might reflect the different mechanisms of action of Botox on bladder dysfunction. Further investigations to confirm this hypothesis are warranted.
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Affiliation(s)
- Yuh-Chen Kuo
- Department of Urology, Yangming Branch of Taipei City Hospital, Taipei 11146, Taiwan.
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Taipei 11146, Taiwan.
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Taipei 11146, Taiwan.
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Ospina-Galeano IA, Medina-Polo J, de la Rosa-Kerhmann S, Villacampa-Aubá F, Guerrero-Ramos F, Passas-Martínez JB. Uso de la onabotulinumtoxina A en pacientes con vejiga hiperactiva idiopática con falta de eficacia, intolerancia o contraindicación para los anticolinérgicos. UROLOGÍA COLOMBIANA 2016. [DOI: 10.1016/j.uroco.2015.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Molina CAF, Lima GJD, Cassini MF, Andrade MFD, Facincani I, Tucci Júnior S. Complications after bladder augmentation in children. Acta Cir Bras 2016; 31 Suppl 1:8-12. [DOI: 10.1590/s0102-86502016001300003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sun Y, Luo D, Tang C, Yang L, Shen H. The safety and efficiency of onabotulinumtoxinA for the treatment of overactive bladder: a systematic review and meta-analysis. Int Urol Nephrol 2015; 47:1779-88. [PMID: 26433883 DOI: 10.1007/s11255-015-1125-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/23/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the impact on safety and efficiency of onabotulinumtoxinA (BOTOX1, Allergan, Inc.) treatment in patients with an overactive bladder. MATERIALS AND METHODS We searched the PubMed(®), Embase(®), and Cochrane Library Databases to identify all randomized controlled trials comparing the outcomes of onabotulinumtoxinA and placebo for overactive bladder. The outcomes included reductions in overactive bladder symptoms or improvements in the function of bladder and the side effects of two treatments. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. RESULTS The study inclusion criteria were met by eight randomized controlled trials involving 1875 patients. The synthesized data from these randomized controlled trials indicated that onabotulinumtoxinA was better than placebo in decreasing most overactive bladder symptoms (p < 0.00001, p < 0.00001, p < 0.00001, p < 0.00001, p = 0.0003) in the micturition, urgency, urinary incontinence, urgency urinary incontinence (UUI), and nocturia per day change, respectively; however, the maximum cystometric capacity change from the baseline appeared not to be significantly different between two methods (p = 0.05). In addition, the side effects in the onabotulinumtoxinA group were more serious than the placebo group (p < 0.00001, p = 0.009, p = 0.07, p < 0.0001, p = 0.03 in the UTI, bacteriuria, dysuria, urinary retention, residual urine volume, respectively). CONCLUSIONS Compared with the placebo, onabotulinumtoxinA had significantly and clinically relevant reductions in overactive bladder symptoms, but it also leaded to more side effects.
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Affiliation(s)
- Yi Sun
- Department of Urology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Deyi Luo
- Department of Urology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Cai Tang
- Department of Urology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lu Yang
- Department of Urology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Shen
- Department of Urology, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Zhou X, Yan HL, Cui YS, Zong HT, Zhang Y. Efficacy and safety of onabotulinumtoxinA in treating neurogenic detrusor overactivity: a systematic review and meta-analysis. Chin Med J (Engl) 2015; 128:963-8. [PMID: 25836619 PMCID: PMC4834015 DOI: 10.4103/0366-6999.154318] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: OnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO. Methods: We searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated. Results: Four publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = −10.91, 95% confidence intervals [CIs] = −14.18–−7.63, P < 0.0001); maximum cystometric capacity (SMD = 146.09, 95% CI = 126.19–165.99, P < 0.0001) and maximum detrusor pressure (SMD = −32.65, 95% CI = −37.83–−27.48, P < 0.0001) indicated that onabotulinumtoxinA was more effective than the placebo, despite the doses of onabotulinumtoxinA. Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with more complications. Urinary tract infections (relative risk [RR] =1.48, 95% CI = 1.20–1.81, P = 0.0002); hematuria (RR = 1.81, 95% CI = 1.00–3.24, P = 0.05) and urinary retention (RR = 5.87, 95% CI = 3.61–9.56, P < 0.0001). Conclusions: This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.
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Affiliation(s)
| | | | | | | | - Yong Zhang
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University; Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing 100050, China
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Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis. Int Urogynecol J 2015; 27:347-54. [DOI: 10.1007/s00192-015-2771-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/18/2015] [Indexed: 01/14/2023]
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Khambati A, Lau S, Gordon A, Jarvi KA. OnabotulinumtoxinA (Botox) nerve blocks provide durable pain relief for men with chronic scrotal pain: a pilot open-label trial. J Sex Med 2014; 11:3072-7. [PMID: 25284738 DOI: 10.1111/jsm.12707] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic scrotal pain (CSP) is a common, often debilitating, condition affecting approximately 4.75% of men. While nerve blocks using local anesthetics usually provide temporary pain relief, there are no publications on the use of longer acting nerve blocks to provide more durable pain relief for men with CSP. AIM The aim of this study was to determine if onabotulinumtoxinA (Botox) cord blocks provide durable pain relief for men with CSP. METHODS In this pilot open-label study, men with CSP who had failed medical management but experienced temporary pain relief from a standard cord block underwent a cord block with 100U Botox. MAIN OUTCOME MEASURES The outcomes measured were changes 1, 3, and 6 months post-Botox injection in (i) a 10-point visual analog scale (VAS) pain score; (ii) scrotal tenderness on a three-point scale as rated by physical examination; and (iii) the Chronic Epididymitis Symptom Index (CESI) to measure the severity and impact of scrotal pain on men. Paired t-tests were used to compare groups. RESULTS Eighteen patients with CSP seen between April and September 2013 had Botox injected as a cord block. At the 1-month follow-up, pain reduction was reported by 72% of patients (mean VAS score: 7.36 vs. 5.61, P < 0.003), while by physical examination 44 and 34% of the men had either complete or partial resolution of scrotal tenderness. In addition, there was also a significant reduction in CESI scores (22.19 vs. 19.25, P < 0.04). At 3 months, 56% had both sustained pain reduction and reduced tenderness based on the VAS score (mean: 7.36 vs. 6.02, P < 0.05) and physical exam. The CESI score continued to be significantly lower. Unfortunately, by 6 months, most men had a return to their baseline levels of pain and tenderness. CONCLUSIONS Our pilot study found that Botox cord blocks provide pain reduction for 3 months or more for most men with CSP.
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Affiliation(s)
- Aziz Khambati
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Knuepfer S, Juenemann KP. Experience with botulinum toxin type A in the treatment of neurogenic detrusor overactivity in clinical practice. Ther Adv Urol 2014; 6:34-42. [PMID: 24489607 DOI: 10.1177/1756287213510962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous system. Neurogenic lower urinary tract dysfunction (LUTD) is a widespread chronic illness that impairs millions of people worldwide. Neurogenic LUTD has a major impact on quality of life, affecting emotional, social, sexual, occupational and physical aspects of daily life, and in addition to the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system. First-line treatment for neurogenic LUTD includes antimuscarinics and some form of catheterization, preferably intermittent self-catheterization. However, the treatment effect is often unsatisfactory, so that other options have to be considered. Moreover, neurogenic LUTD is a challenge because all available treatment modalities (i.e. conservative, minimally invasive and invasive therapies) may fail. In recent years, botulinum neurotoxin type A (BoNT/A) treatment has been shown to be an effective pharmacological therapy option in patients refractory to antimuscarinic and neurogenic detrusor overactivity (NDO). Several studies have shown that BoNT/A injection significantly reduces detrusor muscle overactivity. Also BoNT/A treatment of NDO has revealed a significant improvement of lower urinary tract function with regard to reduced urinary incontinence, reduced detrusor pressure, increased bladder capacity and improved quality of life in NDO.
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Affiliation(s)
- Stephanie Knuepfer
- Spinal Cord Injury Center & Research, University Zürich, Balgrist University Hospital, Zürich, Forchstrasse 340, 8008 CH, Switzerland
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Tirlapur SA, Ni Riordain R, Khan KS. Variations in the reporting of outcomes used in systematic reviews of treatment effectiveness research in bladder pain syndrome. Eur J Obstet Gynecol Reprod Biol 2014; 180:61-7. [PMID: 25020277 DOI: 10.1016/j.ejogrb.2014.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/06/2014] [Accepted: 06/04/2014] [Indexed: 01/08/2023]
Abstract
This paper investigates the quality of outcomes reported in systematic reviews and randomised controlled trials (RCTs) of bladder pain syndrome and its relationship with study quality and journal impact factor. We searched until August 2013 the Cochrane Library, EMBASE, Medline, CINAHL, LILACS and SIGLE, without language restrictions. Quality of outcome reporting in systematic reviews and constituent RCTs was assessed using a 6-point scale. Overall study quality was assessed using the AMSTAR and Jadad scoring systems, and impact factor in the year of publication was noted. Spearman's rank correlation was calculated. There were 8 systematic reviews, with a total of 28 RCTs (1732 patients), reporting 5 outcomes using 19 different measurement scales. The outcomes reported in individual RCTs were urinary symptoms (100%), pain (64%), quality of life (39%), general wellbeing (36%) and bladder capacity (36%). The mean quality of outcomes reported was 1.63 (95% CI 0.29-2.96) for systematic reviews and 3.25 (95% CI 2.80-3.70) for RCTs. The quality of outcomes reported showed correlation with overall study quality (0.90, 95% CI 0.79-0.95, p<0.0001) but not with journal impact factor (0.07, 95% CI -0.31-0.43, p=0.35). Multivariable linear regression showed a relationship between quality of outcome reporting and study quality (β=0.05, p<0.0001), adjusting for effects of study type, impact factor and journal type. There is a need to generate consensus over a set of core outcomes in bladder pain syndrome using standardised reporting tools and to disseminate these through good publication practice.
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Affiliation(s)
- Seema A Tirlapur
- Women's Health Research Unit, Barts and The London School of Medicine, Queen Mary, University of London, Turner Street, London E1 2AB, United Kingdom.
| | - Richeal Ni Riordain
- Barts and The London School of Medicine and Dentistry, London E1 2AB, United Kingdom
| | - Khalid S Khan
- Women's Health Research Unit, Barts and The London School of Medicine, Queen Mary, University of London, Turner Street, London E1 2AB, United Kingdom; Barts Health NHS Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, United Kingdom
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Jhang JF, Jiang YH, Kuo HC. Potential therapeutic effect of intravesical botulinum toxin type A on bladder pain syndrome/interstitial cystitis. Int J Urol 2014; 21 Suppl 1:49-55. [DOI: 10.1111/iju.12317] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/14/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Jia-Fong Jhang
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
| | - Yuan-Hong Jiang
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
| | - Hann-Chorng Kuo
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
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Cui Y, Zhou X, Zong H, Yan H, Zhang Y. The efficacy and safety of onabotulinumtoxinA in treating idiopathic OAB: A systematic review and meta-analysis. Neurourol Urodyn 2014; 34:413-9. [PMID: 24676791 DOI: 10.1002/nau.22598] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/03/2014] [Indexed: 11/08/2022]
Abstract
AIM We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating idiopathic OAB. METHODS A literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of idiopathic OAB. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. RESULTS Eight publications involving a total of 1,320 patients were used in the analysis, including six RCTs that compared onabotulinumtoxinA with placebo. OnabotulinumtoxinA significantly decreased the mean number of urinary incontinence (UI) per day -2.77 versus -1.01 (the standardized mean difference (SMD) = -1.68, 95% CI = -2.06 to -1.31, P < 0.00001); the mean number of micturitions per day -1.61 versus -0.87 (SMD = -1.82, 95% CI = -2.61 to -1.02, P < 0.00001); maximum cystometric capacity (MCC) 91.39 versus 32.32 (SMD = 63.82, 95% CI = 38.14 to 89.50, P < 0.00001) and volume voided 44.29 versus 7.36 (SMD = 33.05, 95% CI = 22.45 to 43.66, P < 0.00001) versus placebo and 29.20% versus 7.95% of patients became incontinence-free (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 3.11 to 7.70, P < 0.00001). Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with complications resulting from postvoid residuals (PVR; P < 0.00001), urinary tract infections (UTI; P < 0.00001) and clean intermittent catheterization (CIC; P < 0.00001). CONCLUSION This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for idiopathic overactive bladder symptoms with side effects primarily localized to urinary tract.
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Affiliation(s)
- Yuanshan Cui
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhou
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, Beijing, China
| | - Huantao Zong
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, Beijing, China
| | - Huilei Yan
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, Beijing, China
| | - Yong Zhang
- Department of Urology, Beijing Tian-Tan Hospital, Capital Medical University, Beijing, China
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Hanna-Mitchell AT, Wolf-Johnston AS, Barrick SR, Kanai AJ, Chancellor MB, de Groat WC, Birder LA. Effect of botulinum toxin A on urothelial-release of ATP and expression of SNARE targets within the urothelium. Neurourol Urodyn 2013; 34:79-84. [PMID: 24167028 DOI: 10.1002/nau.22508] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/13/2013] [Indexed: 11/11/2022]
Abstract
AIMS Botulinum neurotoxin serotype A (BoNT/A) has emerged as an effective treatment of urinary bladder overactivity. Intravesical lipotoxin (BoNT/A delivery using liposomes), which may target the urothelium, is effective in blocking acetic acid induced hyperactivity in animals. The objective of this study was to assess the possible site of toxin action within the urothelium. METHODS We examined expression of the toxin receptor (SV2) and its cleavage targets (SNAP-25 and SNAP-23) within urothelium as well as effects of the toxin on mechanically evoked release of ATP from cultured rat urothelial cells. ATP release was measured using the luciferin-luciferase assay; we examined expression of SNAP-23 and -25 in urothelial cells and mucosa of rat and human bladders. RESULTS BoNT/A (1.5 U; 1-3 hr) blocked hypotonic evoked release of urothelial ATP, without affecting morphology. The expression of protein targets for BoNT/A binding (SV2) was detected in human and rat bladder mucosa and catalytic action (SNAP-23, -25) in urothelial cells and mucosa (differed in intensity) from rat and human bladder. Incubation of cultured (rat) urothelial cells with BoNT/A decreased expression levels of both SNAP-23 (44%) and SNAP-25 (80%). CONCLUSIONS Our findings reveal that the bladder urothelium expresses the intracellular targets and the binding protein for cellular uptake of BoNT/A; and that the toxin is able to suppress the levels of these targets as well as hypotonic-evoked ATP release. These data raise the possibility that intravesical treatment with BoNT/A suppresses bladder reflex and sensory mechanisms by affecting a number of urothelial functions including release of transmitters.
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Affiliation(s)
- Ann T Hanna-Mitchell
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Larsen HF, Jensen TSR, Rasmussen L, Ellebæk M, Qvist N. Intramural injection with botulinum toxin significantly elongates the pig esophagus. J Pediatr Surg 2013; 48:2032-5. [PMID: 24094953 DOI: 10.1016/j.jpedsurg.2013.03.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch. METHODS Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device. RESULTS The mean esophageal elongation was 84% (range 83-101) in the BTX-A-group and 65% (50-78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001). CONCLUSION Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.
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Linsenmeyer TA. Use of botulinum toxin in individuals with neurogenic detrusor overactivity: state of the art review. J Spinal Cord Med 2013; 36:402-19. [PMID: 23941788 PMCID: PMC3739890 DOI: 10.1179/2045772313y.0000000116] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) injection into the bladder wall has been shown to be an effective alternative to anticholinergic (antimuscarinic) medications and more invasive surgery in those with multiple sclerosis and spinal cord injury with neurogenic detrusor overactivity (NDO) and urinary incontinence who are not tolerating anticholinergic medications. In August 2011, Botox(®) (onabotulinumtoxinA) received Food and Drug Administration (FDA) approval for this use. Clinically, intradetrusor injection of BoNT has been found to decrease urinary incontinence and improve quality of life. Its impact on urodynamic parameters is an increase in the maximum cystometric (bladder) capacity and decrease in the maximum detrusor pressures. The most common side effects are urinary tract infections and urinary retention. There have been rare reports and a black box warning of distant spread of BoNT. BoNT has gained popularity because of its effectiveness and long duration of action, relative ease of administration, easy learning curve, reproducibility of results on repeated administration, and low incidence of complications. OBJECTIVE To discuss the structure and function, mechanisms of action, clinical and urodynamic studies, injection technique, potential beneficial and adverse effects, and potential areas of research of BoNT. METHODS Literature search focused on botulinum toxin in MEDLINE/PubMed. Search terms included botulinum toxin, neurogenic bladder, NDO, botox bladder, botox spinal cord injury, botox, FDA, botox side effects. All papers identified were English language, full-text papers. In addition, English abstracts of non-English papers were noted. The reference list of identified articles was also searched for further papers. CONCLUSION Botulinum toxin is an alternative treatment for individuals with NDO who fail to tolerate anticholinergic medications. Its popularity has increased because of the literature, which has supported its effectiveness, safety, easy use and learning curve, reproducibility of results on repeated use, and recent FDA approval of Botox(®) (onabotulinumtoxinA).
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Affiliation(s)
- Todd A. Linsenmeyer
- Correspondence to: Todd A. Linsenmeyer, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur Urol 2013; 64:249-56. [PMID: 23608668 DOI: 10.1016/j.eururo.2013.04.001] [Citation(s) in RCA: 257] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/01/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Overactive bladder (OAB) syndrome with urinary incontinence (UI) is prevalent in the population and impairs health-related quality of life (HRQOL). OBJECTIVE To assess the impact on efficacy, safety, and HRQOL of onabotulinumtoxinA (BOTOX(®), Allergan, Inc.) treatment in patients with OAB with UI. DESIGN, SETTING, AND PARTICIPANTS This pivotal, multicentre, double-blind, randomised, placebo-controlled, phase 3 study enrolled patients with idiopathic OAB with ≥ 3 urgency UI episodes over 3 d and ≥ 8 micturitions per day who were inadequately managed by anticholinergics. INTERVENTION OnabotulinumtoxinA at a 100U dose (n=277) or placebo (n=271), administered as 20 intradetrusor injections of 0.5 ml. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Co-primary end points were change from baseline in the number of UI episodes per day and proportion of patients reporting positive treatment response on the treatment benefit scale (TBS) at week 12. Additional end points included other OAB symptoms (episodes of urinary urgency incontinence, micturition, urgency, and nocturia) and HRQOL (Incontinence Quality of Life [I-QOL], King's Health Questionnaire [KHQ]). Safety assessments included adverse events (AEs), postvoid residual (PVR) urine volume, and initiation of clean intermittent catheterisation (CIC). RESULTS AND LIMITATIONS OnabotulinumtoxinA significantly decreased UI episodes per day at week 12 (-2.95 for onabotulinumtoxinA versus -1.03 for placebo; p<0.001). Reductions from baseline in all other OAB symptoms were also significantly greater following onabotulinumtoxinA compared with placebo (p ≤ 0.01). Patients perceived a significant improvement in their condition, as measured by patients with a positive treatment response on the TBS (62.8% for onabotulinumtoxinA versus 26.8% for placebo; p<0.001). Clinically meaningful improvements from baseline in all I-QOL and KHQ multi-item domains (p<0.001 versus placebo) indicated positive impact on HRQOL. AEs were mainly localised to the urinary tract. Mean PVR was higher in the onabotulinumtoxinA group (46.9 ml versus 10.1 ml at week 2; p<0.001); 6.9% of onabotulinumtoxinA patients versus 0.7% of placebo patients initiated CIC. CONCLUSIONS OnabotulinumtoxinA 100 U was well tolerated and demonstrated significant and clinically relevant improvements in all OAB symptoms, patient-reported benefit, and HRQOL in patients inadequately managed by anticholinergics. TRIAL REGISTRATION ClinicalTrials.gov: NCT00910520.
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Perez-Lloret S, Rey MV, Pavy-Le Traon A, Rascol O. Emerging drugs for autonomic dysfunction in Parkinson's disease. Expert Opin Emerg Drugs 2013; 18:39-53. [DOI: 10.1517/14728214.2013.766168] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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The treatment of lower urinary tract symptoms in patients with multiple sclerosis: a systematic review. Curr Urol Rep 2012; 13:335-42. [PMID: 22886612 DOI: 10.1007/s11934-012-0266-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This is a systematic review on the treatment of lower urinary tract symptoms (LUTS) in patients with multiple sclerosis (MS). The heterogeneity of the outcome criteria did not allow a meta-analysis of the published evidence. In the last few decades, the therapeutic options for neurogenic bladder dysfunction have broadened. Despite this, no consensus has been reached as to the management of LUTD and LUTS in patients with MS, and the subject remains controversial. Bladder dysfunction is common in MS, affecting 80 %-100 % of patients during the course of the disease. Several studies have shown that urinary incontinence has a severe effect on patients' quality of life, with 70 % of patients classifying the impact bladder symptoms had on their life as "high" or "moderate." Moreover, the progressive feature of MS makes its treatment complex, since any achieved therapeutic result may be short-lived, with the possibility that symptoms will recur or develop de novo.
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Hikita K, Honda M, Kawamoto B, Panagiota T, Inoue S, Hinata N, Muraoka K, Takenaka A. Botulinum toxin type A injection for neurogenic detrusor overactivity: Clinical outcome in Japanese patients. Int J Urol 2012; 20:94-9. [DOI: 10.1111/j.1442-2042.2012.03218.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 09/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Katsuya Hikita
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
| | - Masashi Honda
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
| | - Bunya Kawamoto
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
| | - Tsounapi Panagiota
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
| | - Seiya Inoue
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
| | - Nobuyuki Hinata
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
| | - Kuniyasu Muraoka
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
| | - Atsushi Takenaka
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago; Tottori; Japan
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