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Bladder Dysfunction in Older Adults: The Botulinum Toxin Option

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Abstract

Bladder dysfunction, which involves inadequacies of urine storage or emptying, increases with age. Conventional medications may have insufficient efficacy for patients with refractory lower urinary tract symptoms, and their concomitant adverse events (AEs) may be intolerable for the older adult population. For decades, the botulinum toxin type A (BoNT-A) injection has been an option for managing urine frequency, urge incontinence, and voiding dysfunction in the general population refractory to conventional management. This review focuses on studies of BoNT-A application in the management of bladder dysfunction in older adult patients aged ≥ 65 years. In this target population, intravesical BoNT-A injections provide similar efficacy in idiopathic overactive bladder to that in younger adults. Good clinical response has also been demonstrated in older adult patients presenting with storage dysfunction and with various concomitant underlying neurological diseases. However, caution must be taken for the AEs that occur after intravesical BoNT-A injection, including increased post-void residual urine, acute urine retention, and urinary tract infection. Most evidence shows that age is not a major determinant of AEs after adjusting for other factors. In contrast to its application in storage dysfunction, evidence for voiding dysfunction in older adults is scarce. In general, BoNT-A may be a reasonable option for older adult patients with refractory storage dysfunction because of its promising clinical response without significant systemic AEs. Overall, clinicians should be aware of the balance between the therapeutic efficacy of BoNT-A and local AEs in vulnerable members of this population.

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Authors and Affiliations

  1. Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan

    Yao-Lin Kao & Yin-Chien Ou

  2. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan

    Yin-Chien Ou

  3. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, No. 707, Section 3, Chung Yang Road, Hualien, 970, Taiwan

    Hann-Chorng Kuo

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  1. Yao-Lin Kao
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  2. Yin-Chien Ou
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  3. Hann-Chorng Kuo
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Corresponding author

Correspondence to Hann-Chorng Kuo.

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Conflict of interest

Yao-Lin Kao, Yin-Chien Ou, and Hann-Chorng Kuo declare no conflicts of interest.

Funding

The work was supported by grants from the National Cheng Kung University Hospital (NCKUH-11103038).

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Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Author contributions

H-CK: Conceptualization; project administration, supervision, and writing–review and editing. Y-LK: Methodology, resources, and writing–original draft. Y-CO: Visualization, writing–original draft. All authors have read and agreed to the published version of this manuscript.

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Kao, YL., Ou, YC. & Kuo, HC. Bladder Dysfunction in Older Adults: The Botulinum Toxin Option. Drugs Aging 39, 401–416 (2022). https://doi.org/10.1007/s40266-022-00950-1

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  • DOI: https://doi.org/10.1007/s40266-022-00950-1

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