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Intravesical Chemodenervation and Toxins

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Abstract

Treatment for overactive bladder (OAB) with oral pharmacologic therapy can be unsatisfactory, and alternative options should be considered when patients fail. Intravesical therapy with botulinum neurotoxin should be introduced as a third-line treatment option in those OAB patients refractory to oral therapy or intolerant to its systemic side effects. The popularity of intravesical therapy with botulinum toxin has continuously increased due to the literature-supported safety, effectiveness, facile administration, adaptable learning curve, and reproducible effect with repeated use. While vanilloids (capsaicin and resiniferatoxin) are also an available therapeutic option, they are not regularly utilized due to their lack of FDA approval and documented efficacy and safety. The aim of this chapter is to describe the clinical applications of injectable intravesical agents for OAB and discuss their mechanism of action, outcomes, and safety.

Keywords

Overactive bladder Botulinum neurotoxin Capsaicin Resiniferatoxin Vanilloid 

Abbreviations

ACh

Acetylcholine

AUA

American Urological Association

BDNF

Brain-derived neurotrophic factor

BoNT

Botulinum neurotoxin

BoNT-A

Botulinum neurotoxin type A

BoNT-B

Botulinum neurotoxin type B

CIC

Clean intermittent catheterization

DO

Detrusor overactivity

DRG

Dorsal root ganglia

MCC

Maximum cystometric capacity

MDP

Maximal detrusor voiding pressure

NDO

Neurogenic detrusor overactivity

NGF

Nerve growth factor

OAB

Overactive bladder

PVR

Post-voiding residual volume

QoL

Quality of life

RCT

Randomized controlled trial

RTX

Resiniferatoxin

SNAP-25

Synaptosomal-associated protein 25

SNARE

Soluble N-ethylmaleimide-sensitive fusion attachment protein receptor

TRPV1

Transient receptor potential vanilloid 1

U

Unit/units

UTI

Urinary tract infection

UUI

Urgency urinary incontinence

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.University of Southern California, Department of UrologyLos AngelesUSA

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