Botulinum toxin in the management of lower urinary tract dysfunction: contemporary update.
OBJECTIVE
To review the most recent experience concerning the application of botulinum toxin in the human lower urinary tract.


RESULTS
Botulinum toxin was initially applied in the bladder of patients with spinal neurogenic detrusor overactivity and urinary incontinence, or in the urethra in cases of detrusor external sphincter dyssynergia. A large multicentric European study fully confirmed the initial expectancy in the former condition. In addition, the application of botulinum toxin was extended to the treatment of other urological disorders including non-neurogenic detrusor overactivity, non-relaxing urethral sphincter and detrusor underactivity. Interesting reports on the injection of botulinum toxin into the prostate of patients with benign prostatic hyperplasia are also reviewed.


CONCLUSIONS
Bladder injection of botulinum toxin is not yet an approved treatment for lower urinary tract dysfunction. Nevertheless, available data suggest that in the near future the toxin will become a standard therapeutic option in incontinent patients with neurogenic and non-neurogenic forms of overactive bladder, who do not respond to or do not tolerate anticholinergic medication. In addition, it might be expected that urethral botulinum toxin injections improve bladder emptying in patients with dysfunctional voiding problems besides detrusor external sphincter dyssynergia.
Cruz
Francisco
F
Department of Urology, Hospital São João, Alameda Prof Hernâni Montero, 4200-076 Porto, Portugal. cruzfjmr@med.up.pl
Silva
Carlos
C
D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D014522:Urethral Diseases / Q000188:drug therapy*; D001745:Urinary Bladder Diseases / Q000188:drug therapy*
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins