Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Botulinum Toxin Injections for Neurogenic Detrusor Overactivity Medication

  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jan 13, 2016
 
 

Neuromuscular Blockers, Botulinum Toxins

Class Summary

Agents in this class cause presynaptic paralysis of the myoneural junction and reduce abnormal contractions.

Onabotulinumtoxin A (BOTOX)

 

Botulinum toxin may provide relief of spasticity without the systemic adverse effects of other antispasticity agents. Binds to receptor sites on the motor nerve terminals and, after uptake, inhibits the release of acetylcholine, blocking transmission of impulses in neuromuscular tissue.

In treating adult patients for 1 or more indications, the maximum cumulative dose generally should not exceed 360 U in a 3-month period. The recommended treatment dose of onabotulinumtoxin A is 200 U per treatment, divided into 30 injections of 1 mL.

 
Contributor Information and Disclosures
Author

Pamela I Ellsworth, MD Professor of Urology, University of Massachusetts Medical School; Chief, Division of Pediatric Urology, Department of Urology, UMassMemorial Medical Center

Pamela I Ellsworth, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Urological Association, Phi Beta Kappa, Society of University Urologists, Society for Fetal Urology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

References
  1. Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford AP, Davis JB. Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol. 2005 Sep. 174(3):977-82; discussion 982-3. [Medline].

  2. Kuo HC. Clinical effects of suburothelial injection of botulinum A toxin on patients with nonneurogenic detrusor overactivity refractory to anticholinergics. Urology. 2005 Jul. 66(1):94-8. [Medline].

  3. Schurch B, de Seze M, Denys P, Chartier-Kastler E, Haab F, Everaert K. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol. 2005 Jul. 174(1):196-200. [Medline].

  4. Giannantoni A, Di Stasi SM, Stephen RL, Bini V, Costantini E, Porena M. Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol. 2004 Jul. 172(1):240-3. [Medline].

  5. Kim SW, Choi JH, Lee YS, Han SW, Im YJ. Preoperative urodynamic factors predicting outcome of botulinum toxin-A intradetrusor injection in children with neurogenic detrusor overactivity. Urology. 2014 Dec. 84 (6):1480-4. [Medline].

  6. Peyronnet B, Castel-Lacanal E, Manunta A, Roumiguié M, Marque P, Rischmann P, et al. Failure of botulinum toxin injection for neurogenic detrusor overactivity: Switch of toxin versus second injection of the same toxin. Int J Urol. 2015 Sep 22. [Medline].

  7. Khan S, Game X, Kalsi V, Gonzales G, Panicker J, Elneil S. Long-term effect on quality of life of repeat detrusor injections of botulinum neurotoxin-A for detrusor overactivity in patients with multiple sclerosis. J Urol. 2011 Apr. 185(4):1344-9. [Medline].

  8. Kalsi V, Apostolidis A, Popat R, Gonzales G, Fowler CJ, Dasgupta P. Quality of life changes in patients with neurogenic versus idiopathic detrusor overactivity after intradetrusor injections of botulinum neurotoxin type A and correlations with lower urinary tract symptoms and urodynamic changes. Eur Urol. 2006 Mar. 49(3):528-35. [Medline].

 
Previous
Next
 
Injection sites using minimally invasive outpatient technique. Flexible cystoscope with superfine 27-gauge disposable needle is used to inject onabotulinumtoxinA (BOTOX; Allergan, Irvine, CA) into bladder while avoiding trigone. At equally spaced points, 30 distinct injections, each containing 1 mL, are introduced
Gross anatomy of the bladder.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.