The unusual history and the urological applications of botulinum neurotoxin.
BACKGROUND
Botulinum neurotoxin (BoNT) is probably the most potent biological toxin that can affect humans. Since its discovery by Justinus Kerner, BoNT has seen use in a wide range of cosmetic and non-cosmetic conditions such as cervical dystonia, cerebral palsy, migraines and hyperhidrosis. We tried to trace its history from its inception to its recent urological applications.


METHODS
Historical articles about botulinum toxin were reviewed and a Medline search was performed for its urological utility. We hereby present a brief review of historical aspects of BoNT and its applications in urology.


RESULTS
In 1793, the first known outbreak of botulism occurred due to 'spoiled' sausage in Wildebad, Germany. The German physician and poet Justinus Kerner published the first accurate description of the clinical symptoms of botulism (sausage poison). He was also the first to mention its potential therapeutic applications. In urology, BoNT has been used in bladder and urethral lesions with varying degree of success. Recently, BoNT applications were explained for prostatic disorders. BoNT applications in urology are in the treatment of detrusor external sphincter dyssynergia, detrusor overactivity, detrusor underactivity, spastic conditions of the urethral sphincter, chronic prostate pain, interstitial cystitis, non-fibrotic bladder outflow obstruction (including benign prostatic hyperplasia) and acute urinary retention in women.


CONCLUSIONS
Justinus Kerner is the godfather of botulism research. The role of BoNT in urology has evolved exponentially and it is widely used as an adjuvant in voiding dysfunction. In the future, its utility will broaden and guide the urologist in managing various urological disorders.
Hanchanale
Vishwanath S
VS
Lancashire Teaching Hospitals NHS Trust, Preston, UK. vishwanath.hanchanale@gmail.com
Rao
Amrith Raj
AR
Martin
Francis L
FL
Matanhelia
Shyam S
SS
D001905:Botulinum Toxins / Q000266:history / Q000627:therapeutic use*; D001906:Botulism / Q000266:history; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D006801:Humans; D016896:Treatment Outcome; D014521:Urethra / Q000187:drug effects* / Q000503:physiopathology; D001743:Urinary Bladder / Q000187:drug effects* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000503:physiopathology; D016055:Urinary Retention / Q000188:drug therapy / Q000503:physiopathology; D014555:Urination Disorders / Q000188:drug therapy* / Q000266:history / Q000503:physiopathology; D014572:Urology / Q000266:history / Q000379:methods*
D001905:Botulinum Toxins