Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Feb;5(1):63-71.
doi: 10.3978/j.issn.2223-4683.2016.01.10.

The role of botulinum toxin A in treating neurogenic bladder

Filip Weckx  1 , Manuela Tutolo  1 , Dirk De Ridder  1 , Frank Van der Aa  1
Affiliations
Review

The role of botulinum toxin A in treating neurogenic bladder

Filip Weckx et al. Transl Androl Urol. 2016 Feb.

Abstract

Neurogenic detrusor overactivity (NDO) can result in lower and upper urinary tract complications and eventually even in end-stage kidney failure. Since the driving force of this clinical cascade is high bladder pressure, controlling intravesical pressure in NDO patients improves both quality of life and life-expectancy in these patients. Botulinum toxin A (BTX-A) has proven its efficacy in reducing intravesical pressure and in reducing incontinence episodes. BTX-A also improves quality of life in patients with NDO. Both onabotulinumtoxinA (Botox(®), Allergan, Irvine, USA) and abobotulinumtoxinA (Dysport(®), Ipsen, Paris, France) have a level A recommendation for NDO-treatment. The recommended dose for intradetrusor injections in NDO patients is 200 U of onabotulinumtoxinA or 500 U of abobotulinumtoxinA. The drug is generally administered extratrigonal in the detrusor muscle, via cystoscopic guided injection at 20 sites in 1 mL injections. Intradetrusor BTX-A injections are safe, with mostly local complications such as urinary tract infection and high post-void residual or retention. The effect of the toxin lasts for approximately 9 months. Repeat injections can be performed without loss of efficacy. Different injection techniques, novel ways of BTX-A administration, eliminating the need for injection or new BTX-A types with better/longer response rates could change the field in the future.

Keywords: Botulinum toxin; abobotulinumtoxinA; neurogenic bladder; neurogenic detrusor overactivity; onabotulinumtoxinA.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: F Van der Aa has received institutional research grants from Allergan, Astellas and Ipsen. The other authors have no conflicts of interest to declare.

References

    1. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci 2008;9:453-66. - PMC - PubMed
    1. Aoki KR, Guyer B. Botulinum toxin type A and other botulinum toxin serotypes: a comparative review of biochemical and pharmacological actions. Eur J Neurol 2001;8 Suppl 5:21-9. - PubMed
    1. Tanagho EA, McAninch JW, editors. Smith’s General Urology. 17th ed. New York: The McGraw-Hill Companies, Inc., 2008,438–53.
    1. Sellers DJ, McKay N. Developments in the pharmacotherapy of the overactive bladder. Curr Opin Urol 2007;17:223-30. - PubMed
    1. Chancellor MB, Elovic E, Esquenazi A, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of urologic conditions. Toxicon 2013;67:129-40. - PubMed