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Neurotoxin Use for Voiding Dysfunction

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Abstract

Botulinum neurotoxin injection into the urethral sphincter has been shown to be effective in the treatment of neurogenic and non-neurogenic detrusor-sphincter dyssynergia. In this article, we review the rationale for, technique used in, and results of pelvic floor botulinum toxin injection. Clinicians should note that botulinum injection into the pelvic floor and urethral sphincter currently represents off-label use.

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References

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  1. Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol. 1988;139(5):919–22.

    PubMed  CAS  Google Scholar 

  2. Smith CP, Nishiguchi J, O’Leary M, Yoshimura N, Chancellor MB. Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology. 2005;65(1):37–41.

    Article  PubMed  Google Scholar 

  3. Smith CP, O’Leary M, Erickson J, Somogyi GT, Chancellor MB. Botulinum toxin urethral sphincter injection resolves urinary retention after pubovaginal sling operation. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):55–6.

    Article  PubMed  CAS  Google Scholar 

  4. Smith CP, Chancellor MB. Emerging role of botulinum toxin in the management of voiding dysfunction. J Urol. 2004;171(6 Pt 1):2128–37.

    Article  PubMed  CAS  Google Scholar 

  5. Novak I, Campbell L, Boyce M, Fung VS. Botulinum toxin assessment, intervention and aftercare for cervical dystonia and other causes of hypertonia of the neck: international consensus statement. Eur J Neurol. 2010;17 Suppl 2:94–108.

    Article  PubMed  Google Scholar 

  6. Jabbari B. Botulinum neurotoxins in the treatment of refractory pain. Nat Clin Pract Neurol. 2008;4(12):676–85.

    Article  PubMed  CAS  Google Scholar 

  7. Bhidayasiri R, Cardoso F, Truong DD. Botulinum toxin in blepharospasm and oromandibular dystonia: comparing different botulinum toxin preparations. Eur J Neurol. 2006;13 Suppl 1:21–9.

    Article  PubMed  Google Scholar 

  8. Albanese A. Terminology for preparations of botulinum neurotoxins: what a difference a name makes. JAMA. 2011;305(1):89–90.

    Article  PubMed  CAS  Google Scholar 

  9. • Chen SL, Bih LI, Chen GD, Huang YH, You YH, Lew HL. Transrectal ultrasound-guided transperineal botulinum toxin A injection to the external urethral sphincter for treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury. Arch Phys Med Rehabil. 2010;91(3):340–344. This is an excellent recent description of the technique of urethral sphincter botulinum toxin injection in spinal cord–injured patients with DSD. Technique with illustration is provided to guide the clinician.

    Article  PubMed  Google Scholar 

  10. de Seze M, Petit H, Gallien P, et al. Botulinum A toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur Urol. 2002;42(1):56–62.

    Article  PubMed  Google Scholar 

  11. Gallien P, Reymann JM, Amarenco G, Nicolas B, de Seze M, Bellissant E. Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J Neurol Neurosurg Psychiatry. 2005;76(12):1670–6.

    Article  PubMed  CAS  Google Scholar 

  12. Phelan MW, Franks M, Somogyi GT, et al. Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol. 2001;165(4):1107–10.

    Article  PubMed  CAS  Google Scholar 

  13. Kuo HC. Recovery of detrusor function after urethral botulinum A toxin injection in patients with idiopathic low detrusor contractility and voiding dysfunction. Urology. 2007;69(1):57–61. discussion 61–62.

    Article  PubMed  Google Scholar 

  14. Kuo HC. Effectiveness of urethral injection of botulinum A toxin in the treatment of voiding dysfunction after radical hysterectomy. Urol Int. 2005;75(3):247–51.

    Article  PubMed  CAS  Google Scholar 

  15. FitzGerald MP, Brubaker L. The etiology of urinary retention after surgery for genuine stress incontinence. Neurourol Urodyn. 2001;20(1):13–21.

    Article  PubMed  CAS  Google Scholar 

  16. Ghazizadeh S, Nikzad M. Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol. 2004;104(5 Pt 1):922–5.

    Article  PubMed  CAS  Google Scholar 

  17. Jarvis SK, Abbott JA, Lenart MB, Steensma A, Vancaillie TG. Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles. Aust N Z J Obstet Gynaecol. 2004;44(1):46–50.

    Article  PubMed  Google Scholar 

  18. Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol. 2006;108(4):915–23.

    Article  PubMed  Google Scholar 

  19. Gunter J, Brewer A, Tawfik O. Botulinum toxin a for vulvodynia: a case report. J Pain. 2004;5(4):238–40.

    Article  PubMed  Google Scholar 

  20. • Abbott J. The use of botulinum toxin in the pelvic floor for women with chronic pelvic pain—a new answer to old problems? J Minim Invasive Gynecol. 2009;16(2):130–135. A leader in the application of botulinum toxin in urogynecology, Abbott reports on the how and why of pelvic floor injection of botulinum toxin in women with pelvic floor pain and spasm.

    Article  PubMed  Google Scholar 

  21. Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin type A—a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J Sex Med. 2009;6(9):2523–37.

    Article  PubMed  CAS  Google Scholar 

  22. Romito S, Bottanelli M, Pellegrini M, Vicentini S, Rizzuto N, Bertolasi L. Botulinum toxin for the treatment of genital pain syndromes. Gynecol Obstet Invest. 2004;58(3):164–7.

    Article  PubMed  CAS  Google Scholar 

  23. Chuang YC, Chancellor MB. The application of botulinum toxin in the prostate. J Urol. 2006;176(6 Pt 1):2375–82.

    Article  PubMed  CAS  Google Scholar 

  24. Chuang YC, Huang CC, Kang HY, et al. Novel action of botulinum toxin on the stromal and epithelial components of the prostate gland. J Urol. 2006;175(3 Pt 1):1158–63.

    Article  PubMed  CAS  Google Scholar 

  25. Zermann D, Ishigooka M, Schubert J, Schmidt RA. Perisphincteric injection of botulinum toxin type A. A treatment option for patients with chronic prostatic pain? Eur Urol. 2000;38(4):393–9.

    Article  PubMed  CAS  Google Scholar 

  26. Gottsch HP, Yang CC, Berger RE. A pilot study of botulinum toxin A for male chronic pelvic pain syndrome. Scand J Urol Nephrol. 2011;45(1):72–6.

    Article  PubMed  CAS  Google Scholar 

  27. Chen YH, Kuo HC. Botulinum A toxin treatment of urethral sphincter pseudodyssynergia in patients with cerebrovascular accidents or intracranial lesions. Urol Int. 2004;73(2):156–61. discussion 161–152.

    Article  PubMed  CAS  Google Scholar 

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Disclosure

Dr. Chancellor has served as a consultant for, received grant support from, received honoraria from, received payment for development of educational presentations (including service on speakers’ bureaus) from, and had travel expenses/accommodations covered or reimbursed by Allergan.

Dr. Chuang has served as an investigator and speaker for Allergan.

Dr. Wang reported no potential conflicts of interest relevant to this article.

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Correspondence to Michael B. Chancellor.

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Wang, HJ., Chuang, YC. & Chancellor, M.B. Neurotoxin Use for Voiding Dysfunction. Curr Bladder Dysfunct Rep 6, 182–189 (2011). https://doi.org/10.1007/s11884-011-0096-5

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