title: Use of botulinum toxin for genitourinary conditions: What is the evidence?
abstract: Botulinum toxin A is licensed for the treatment of urinary incontinence due to neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). Only onabotulinumtoxinA has at this moment such approval, in NDO at a dose of 200 U and in OAB at a dose of 100 U. Regulatory phase 3 trials have been carried out in both conditions. In NDO it was shown to decrease urinary incontinence, to improve urodynamic parameters and to increase quality of life in multiple sclerosis and spinal cord injured patients. Adverse events included urinary tract infections and necessity of de novo clean intermittent catheterization, which occurred mainly in patients with multiple sclerosis. In OAB patients with urge incontinence, onabotulinumtoxinA decreased urinary incontinence and micturition frequency while improving quality of life. Again, main adverse events were urinary tract infections and transient urinary retentions. Long-term studies in both NDO and OAB demonstrate the efficacy and safety of the treatment. Available phase 3 trials of onabotulinumtoxinA in benign prostatic hyperplasia did not show any relevant efficacy in improving lower urinary tract symptoms.
authors.affiliation: Department of Urology, Hospital S. João, Porto, Portugal; Faculty of Medicine and Institute for Molecular and Cell Biology (IBMC) of the University of Porto, Portugal.
authors.forename: Carlos Martins
authors.initials: CM
authors.lastname: da Silva
authors.affiliation: Department of Urology, Beaumont Health System, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA. Electronic address: chancellormb@gmail.com.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Chancellor
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Christopher Patrick
authors.initials: CP
authors.lastname: Smith
authors.affiliation: Department of Urology, Hospital S. João, Porto, Portugal; Faculty of Medicine and Institute for Molecular and Cell Biology (IBMC) of the University of Porto, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Cruz
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D006801:Humans; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy; D014549:Urinary Incontinence / Q000188:drug therapy*
chemical_list: D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A
keywords: Benign prostatic hyperplasia; Bladder; Botulinum toxin; Neurogenic detrusor overactivity; OnabotulinumtoxinA; Overactive bladder