Botulinum Toxin A in Clinical Practice, the Technical Aspects and What Urologists Want to Know about It

Objectives: To give an overview of the literature concerning the clinical practice of Botulinum toxin A (BTA) treatment to meet the needs and knowledge of urologists. Methods: A literature search was performed to BTA treatment, together with a survey among Dutch urologist. Results: The registration trials used strict inclusion and exclusion criteria, a standardized application technique and follow-up. The approval for BTA is based on these trials but differs from country to country. BTA was already used before these approvals, with different application techniques. Published manuscripts about application techniques (trigone sparing/suburothelial injections/intradetrusor injections) show different outcomes. In literature there is no positive or negative predictor found with a preoperatively urodynamic investigation. It is shown that retreatment does not cause inflammatory infiltration or fibrosis in the bladder wall. The survey showed that in 96% of the urology departments BTA is used. Urodynamic investigation is requested by 87% of urologists before the treatment. Although it is regarded as an easy-to-learn procedure 60% of urologists would like training in practical aspects. Conclusions: No firm data exist about the technique of application with consequently the most optimal results. BTA treatment is regarded as an easy-to-learn, but still there is a request for training in practical treatment aspects. (C) 2015 S. Karger AG, Basel