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Ten years single surgeon experience with botulinum toxin in the urinary tract; clinical observations and research discovery

  • Urology - Review
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

This review details a single surgeon’s 10-year experience with botulinum toxin (BoNT) for lower urinary tract symptoms (LUTS).

Methods

Review of author’s published clinical and research experience with BoNT in the prostate, bladder and urethral sphincter.

Results

Key observations include that an approximate 90% decrease is needed for bladder augmentation and reconstruction. Detrusor compliance and vesicoureteral reflux improved in over 50% of patients. Submucosal and trigone injection had similar efficacy with low rate of retention that can benefit patients with sensory urgency. No case of clinical vesicoureteral reflux has been noted with trigone injection technique. Dose of less than 200 U are clinically beneficial with duration of efficacy increasing with subsequent BoNT injection that may result in improved health economics benefits. Symptom improvement commonly lasts no less than 12 months with prostate injection. Experiment evidences that BoNT blocks sensory neurotransmitter release that has correlated with benefits seen in patients with bladder pain and abacterial prostatitis. Similar efficacy is observed in refractory overactive bladder as with neurogenic and idiopathic detrusor overactivity.

Conclusions

BoNT is promising for a variety of LUTS in author’s personal experience over the past 10 years with research that advanced our understanding of BoNT mechanisms of action in the sensory nerves and prostate gland. International multicenter randomized trials for bladder and prostate indications are currently ongoing seeking regulatory approval.

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Abbreviations

IPSS:

International Prostate Symptoms Score

QoL:

Quality of life

Qmax:

Maximum urinary flow rate

PV:

Prostate volume

PVR:

Post-void residual volume

NA:

Not applicable

NRM:

Inadequate responses or intolerable side effects to α-blockers

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Acknowledgments

Two important friends who trained with me and who have maintained collaboration are Yao-Chi Chuang, MD, Associate Professor at the Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan and Christopher Smith, MD, Associate Professor at the Baylor School of Medicine, Houston, TX. Margie O’Leary, R. N. has been my clinical treatment and education partner.

There are many wonderful people who assisted in my work with BoNT research and care including Roger Aoki, A. Apostolidis, Tim Boone, Dennis Dykstra, Janet Erickson, Cindy Young, William deGroat, Pradeep Tyagi, Fernanado de Miguel, George Somogi, Hann-Chorng Kuo, Ken Peters, Ananias Diokno, Frank Costa, Clair Fowler, Antonella Giannantoni, Cristian Ilie, Alex Lin, Michael Franks, Matt Fraser, Rock Heyman, D. K. Kim, John Lavelle, Wendy Leng, Briqan McNeil, Sara Misplay, Shelby Morrisore, June Nishiguchi, Michael Phelan, Marc Smaldone, Cathy Thomas, P. Radziszewski Poland, Teru Yokoyama, Naoki Yoshimura.

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Authors and Affiliations

  1. Department of Urology, William Beaumont Hospital, 3535 W. 13 Mile Road, Suite 430 MOB, Royal Oak, MI, 48073, USA

    Michael B. Chancellor

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  1. Michael B. Chancellor
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Correspondence to Michael B. Chancellor.

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Chancellor, M.B. Ten years single surgeon experience with botulinum toxin in the urinary tract; clinical observations and research discovery. Int Urol Nephrol 42, 383–391 (2010). https://doi.org/10.1007/s11255-009-9600-7

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