Intravesical Chemodenervation and Toxins



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.


Overactive bladder Botulinum neurotoxin Capsaicin Resiniferatoxin Vanilloid 





American Urological Association


Brain-derived neurotrophic factor


Botulinum neurotoxin


Botulinum neurotoxin type A


Botulinum neurotoxin type B


Clean intermittent catheterization


Detrusor overactivity


Dorsal root ganglia


Maximum cystometric capacity


Maximal detrusor voiding pressure


Neurogenic detrusor overactivity


Nerve growth factor


Overactive bladder


Post-voiding residual volume


Quality of life


Randomized controlled trial




Synaptosomal-associated protein 25


Soluble N-ethylmaleimide-sensitive fusion attachment protein receptor


Transient receptor potential vanilloid 1




Urinary tract infection


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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