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Minimally Invasive Therapy for Urinary Incontinence and Pelvic Organ Prolapse pp 135–154Cite as

Intravesical Therapy for Refractory Overactive Bladder and Detrusor Overactivity in Adults: Botulinum Toxin-A

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Part of the book series: Current Clinical Urology ((CCU))

Abstract

It has been 11 years since the first publications on the use of intradetrusor botulinum toxin-A (BTX-A) injections to treat neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI) OnabotulinumtoxinA (Botox®; Allergan, Ltd., Irvine, USA) has recently been approved for use in the bladder of neurogenic patients with spinal cord injury or multiple sclerosis in various parts of the world including the USA and UK. In the near future, it is expected that the FDA in the USA and the MHRA in Europe will approve the use of this toxin in idiopathic detrusor overactivity (IDO). Over the last decade, there has been an explosion of publications on the use of this bladder therapy which is primarily used in patients with symptoms of overactive bladder (OAB) and/or detrusor overactivity (DO) who have failed conservative measures and oral medication with antimuscarinics. This is typically due to poor efficacy with antimuscarinics or poor tolerability due to side effects such as dry mouth, dry eyes, blurred vision and constipation. Initially proof of concept/open labelled studies were conducted, whilst later studies focussed on mechanisms of action. From these studies it became apparent that BTX was not simply working by efferent blockade at the neuromuscular junction, as in skeletal muscle, but was likely to have an effect on sensory nerves. Later publications emerged on technique of administration and evidence from level 1 small randomised blinded placebo-controlled trials in both NDO and IDO. Recently drug sponsored phase II and III double-blind randomised placebo-controlled trials have been conducted in both NDO and IDO. These trials are now published with the exception of the phase III data in IDO at the present time.

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Acknowledgments

A Sahai, MS Khan and P Dasgupta acknowledges financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. They also acknowledge the support of the MRC Centre for Transplantation. Christopher Dowson for his assistance with the figures in the chapter.

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  1. Department of Urology, Guy’s Hospital, MRC Center for Transplantation, King’s College London, King’s Health Partners, London, UK

    Arun Sahai Ph.D., F.R.C.S. (Urol.), Muhammed Shamim Khan F.R.C.S. (Urol.), F.E.B.U. & Prokar Dasgupta M.B.B.S., M.Sc. (Urol.), M.D., D.L.S., F.R.C.S. (Urol.), F.E.B.U.

  2. Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK

    Jai Seth B.Sc., M.Sc., M.R.C.S.

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  1. Arun Sahai Ph.D., F.R.C.S. (Urol.)
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  2. Jai Seth B.Sc., M.Sc., M.R.C.S.
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  3. Muhammed Shamim Khan F.R.C.S. (Urol.), F.E.B.U.
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  4. Prokar Dasgupta M.B.B.S., M.Sc. (Urol.), M.D., D.L.S., F.R.C.S. (Urol.), F.E.B.U.
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Correspondence to Arun Sahai Ph.D., F.R.C.S. (Urol.) .

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  1. Department of Urology, Wake Forest University, Winston-Salem, North Carolina, USA

    Gopal H. Badlani

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Sahai, A., Seth, J., Khan, M.S., Dasgupta, P. (2014). Intravesical Therapy for Refractory Overactive Bladder and Detrusor Overactivity in Adults: Botulinum Toxin-A. In: Badlani, G. (eds) Minimally Invasive Therapy for Urinary Incontinence and Pelvic Organ Prolapse. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-0008-4_12

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