Botulinum toxin for the management of bladder dysfunction.

Details

Serval ID
serval:BIB_6D5AFBE3AD2E
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Botulinum toxin for the management of bladder dysfunction.
Journal
Drugs
Author(s)
Schurch B.
ISSN
0012-6667 (Print)
ISSN-L
0012-6667
Publication state
Published
Issued date
2006
Volume
66
Number
10
Pages
1301-1318
Language
english
Notes
Publication types: Journal Article ; ReviewPublication Status: ppublish
Abstract
This review highlights a recent innovation in the medical treatment of detrusor overactivity (DO). Anticholinergics are usually the gold standard to treat bladder overactivity. Adverse effects and lack of efficacy are the two main causes for considering alternative treatments. Until recently, invasive surgery (mainly bladder augmentation) was the only available treatment option for patients with intractable DO. This article considers botulinum toxin type A (BTX-A) injection as an alternative treatment to surgery in patients with DO who do not respond to anticholinergic therapy. To identify papers for inclusion in this review, we searched PubMed with the keywords 'botulinum toxin', 'overactive bladder', 'urinary incontinence' and 'neurogenic bladder' for the years 2000-5. Review articles were not included. Abstracts were cited only if they contained important new information. Experimental animal studies and articles or book chapters related to the use of botulinum toxin for other indications (such as achalasia and cervical dystonia) were analysed with regard to the mechanisms of action of botulinum toxin. From this review, it appears that BTX-A injection into the detrusor muscle is a very effective method for treating urinary incontinence secondary to neurogenic detrusor overactivity (NDO), as well as urinary incontinence due to idiopathic overactive bladder (IDO). In both conditions, the duration of effect seems to be at least 6 months. Overall success rates seem to be similar in both patient populations. For NDO, only one evidence-based medicine level 1 study is available, whereas for IDO, only evidence-based medicine level 3 or 4 studies have been published. Particularly in this latter indication, injection technique and outcome parameters vary from study to study and need to be standardised. Without randomised controlled studies aimed at comparing different techniques and dosages, it remains difficult to decide what technique is optimal for treating patients with IDO who are not willing to perform clean intermittent self-catheterisation (CISC). Therefore, studies that compare different dosages and techniques with the risk of needing CISC in regard to the duration of the effect are mandatory. As more studies of repeated injections have been published, it appears that, at least at medium follow-up, the toxin remains as effective as after the first injection, and there is no evidence of change in bladder compliance or detrusor fibrosis. However, long-term observational studies are necessary to assess these last points. Finally, the commonly reported dose appears to be well tolerated, since few adverse effects have been reported.
Keywords
Animals, Botulinum Toxins, Type A/administration & dosage, Botulinum Toxins, Type A/adverse effects, Humans, Injections, Intramuscular/adverse effects, Meta-Analysis as Topic, Muscle, Smooth/injuries, Neuromuscular Agents/administration & dosage, Neuromuscular Agents/adverse effects, Urinary Bladder/drug effects, Urinary Bladder/pathology, Urinary Bladder, Neurogenic/drug therapy, Urinary Bladder, Neurogenic/physiopathology
Pubmed
Web of science
Create date
05/11/2014 13:12
Last modification date
20/08/2019 15:27
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