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Prospects and limitations of treatment with botulinum neurotoxin type A for patients with refractory idiopathic detrusor overactivity


Schmid, D M; Roy, S; Sulser, T; Scheiner, D (2008). Prospects and limitations of treatment with botulinum neurotoxin type A for patients with refractory idiopathic detrusor overactivity. BJU International, 102(Suppl ):7-10.

Abstract

In this review we summarize the recent innovation of botulinum-A neurotoxin (BoNT-A) injections in the bladder as a potential new treatment option for idiopathic detrusor overactivity, refractory to conventional anticholinergic medication. BoNT-A is produced by Clostridium botulinum and consists of a 150-kDa neurotoxic protein that has the ability to cleave proteins within the nerve terminal. BoNT-A is thereby able to prevent acetylcholine release at the presynaptic membrane, resulting in a chemodenervation of the detrusor muscle after intravesical injection; this can reduce symptoms in patients with refractory idiopathic detrusor overactivity. BoNT-A intradetrusor injections might be an alternative to invasive surgery for patients in whom conservative measures and anticholinergic treatment have failed. Clinical studies with different dosages and injection protocols show success rates of 60-96% for neurogenic and non-neurogenic detrusor overactivity, with wide variations in the duration of response. The drug is still under development for the indication of idiopathic detrusor overactivity, and is under ongoing investigation for long-term efficacy and safety.

In this review we summarize the recent innovation of botulinum-A neurotoxin (BoNT-A) injections in the bladder as a potential new treatment option for idiopathic detrusor overactivity, refractory to conventional anticholinergic medication. BoNT-A is produced by Clostridium botulinum and consists of a 150-kDa neurotoxic protein that has the ability to cleave proteins within the nerve terminal. BoNT-A is thereby able to prevent acetylcholine release at the presynaptic membrane, resulting in a chemodenervation of the detrusor muscle after intravesical injection; this can reduce symptoms in patients with refractory idiopathic detrusor overactivity. BoNT-A intradetrusor injections might be an alternative to invasive surgery for patients in whom conservative measures and anticholinergic treatment have failed. Clinical studies with different dosages and injection protocols show success rates of 60-96% for neurogenic and non-neurogenic detrusor overactivity, with wide variations in the duration of response. The drug is still under development for the indication of idiopathic detrusor overactivity, and is under ongoing investigation for long-term efficacy and safety.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Gynecology
04 Faculty of Medicine > University Hospital Zurich > Urological Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:July 2008
Deposited On:07 Nov 2008 08:18
Last Modified:05 Apr 2016 12:25
Publisher:Wiley-Blackwell
ISSN:1464-4096
Additional Information:The definitive version is available at www.blackwell-synergy.com
Publisher DOI:10.1111/j.1464-410X.2008.07827.x
PubMed ID:18665972
Permanent URL: http://doi.org/10.5167/uzh-3110

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