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Botulinum Toxin—What Urologic Uses Does the Data Support?

  • Female Urology (H Goldman, Section Editor)
  • Published:
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Abstract

Botulinum toxin-A (BTX-A) is well established in the management of various aspects of lower urinary tract dysfunction (LUTD). One formulation, OnabotulinumtoxinA has recently been licensed in many parts of the world for use in neurogenic detrusor overactivity (NDO), and in the US for idiopathic overactive bladder (OAB), in patient’s refractory to antimuscarinics. This review article looks at recent clinical publications that examine the use of BTX-A for the treatment of LUTD with a focus on OAB, detrusor overactivity (DO), benign prostatic hyperplasia (BPH) and Painful bladder syndrome / interstitial cystitis (PBS / IC). A literature review was conducted using the PubMed database and studies that were published within the time frame of January 2011 to present were included. Large randomised placebo controlled trials and a pooled analysis of patients with multiple sclerosis / spinal cord injury and NDO has suggested that BTX-A improved urinary incontinence (UI) episodes, urodynamic parameters and QoL in these patients. 200 U of OnabotulinumtoxinA appeared equivalent to 300 U. In patients with OAB, lower doses of 100 U OnabotulinumtoxinA, appear efficacious and with an acceptable adverse event profile. In one large phase III trial, de novo clean intermittent catheterisation rates were 6.1 %. Repeated injections in DO appear efficacious. Results from BPH studies are mixed, and the largest randomised study in this setting has shown significant improvements in a number of parameters for a variety of OnabotulinumtoxinA doses, but none of the doses were statistically better than placebo. Few studies have been conducted in PBS / IC and larger scale randomised placebo controlled trials are required to validate its use in this setting.

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Acknowledgments

JS acknowledges financial support from the InComb project and would like to acknowledge UCLH/UCL Institute of Neurology. AS, PD acknowledge 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.

Disclosure

Dr. Jai Seth reported receiving a grant from The Urology Foundation. Dr. Seth has also received travel accommodations from Astellas and honoraria from Allergan.

Dr. Mohammad Shamim Khan reported receiving a grant and travel accommodations from Allergan.

Dr. Prokar Dasgupta reported receiving a grant from Allergan.

Dr. Arun Sahai reported receiving a grant from Allergan and honoraria from Allergan, Pfizer and Astellas for presentations. Dr. Sahai received travel accommodations from Allergan and Astellas. He has completed / is currently conducting trial work for AMS, Allergan, and Astellas.

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Authors and Affiliations

  1. Department of Uro-Neurology, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK

    J. Seth

  2. MRC Centre for Transplantation, King’s College London, King’s Health Partners, Department of Urology, Guy’s Hospital, London, SE1 9RT, UK

    J. Seth, M. S. Khan, P. Dasgupta & A. Sahai

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  1. J. Seth
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  2. M. S. Khan
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Seth, J., Khan, M.S., Dasgupta, P. et al. Botulinum Toxin—What Urologic Uses Does the Data Support?. Curr Urol Rep 14, 227–234 (2013). https://doi.org/10.1007/s11934-013-0326-9

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