Current and potential urological applications of botulinum toxin A

Intravesical injections of botulinum toxin subtype A (BoNT-A) are approved by the US FDA for the indications of neurogenic detrusor overactivity and idiopathic overactive bladderResults of phase III clinical trials have demonstrated that BoNT-A injections are superior to placebo; patients receiving BoNT-A have fewer lower urinary tract symptoms (LUTS) and a better quality of lifeIntravesical BoNT-A injections carry a risk of adverse events (such as increased post-void residual volume, acute urinary retention and UTI); thus, informed consent must be given before treatmentThe latest randomized control trials have failed to demonstrate any superiority of BoNT-A over placebo injections for the treatment of LUTS owing to BPHClinical trials investigating BoNT-A for the treatment of interstitial cystitis/bladder pain syndrome have shown promising therapeutic effects in reducing bladder pain, repeat injections provide therapeutic effects of a longer durationUrethral BoNT-A injections decrease urethral resistance in patients with voiding dysfunction or detrusor–sphincter dyssynergia; effectiveness of BoNT-A injections in patients with non-neurogenic dysfunctional voiding or inadequate urethral relaxation is unclear