scholarly journals Mechanism of Action of Botulinum Toxin A in Treatment of Functional Urological Disorders

Toxins ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 129 ◽  
Author(s):  
Yu-Hua Lin ◽  
Bing-Juin Chiang ◽  
Chun-Hou Liao
Keyword(s):  
Botulinum Toxin ◽  
Overactive Bladder ◽  
Detrusor Overactivity ◽  
Botulinum Toxin A ◽  
Chronic Pelvic Pain Syndrome ◽  
Atp Release ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Detrusor Muscle ◽  
Urological Disorders

Intravesical botulinum toxin (BoNT) injection is effective in reducing urgency and urinary incontinence. It temporarily inhibits the detrusor muscle contraction by blocking the release of acetylcholine (Ach) from the preganglionic and postganglionic nerves in the efferent nerves. BoNT-A also blocks ATP release from purinergic efferent nerves in the detrusor muscle. In afferent nerves, BoNT-A injection markedly reduces the urothelial ATP release and increases nitric oxide (NO) release from the urothelium. BoNT-A injection in the urethra or bladder has been developed in the past few decades as the treatment method for detrusor sphincter dyssyndergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders, including bladder hypersensitivity, overactive bladder, and interstitial cystitis/chronic pelvic pain syndrome. Although the FDA only approved BoNT-A injection treatment for neurogenic detrusor overactivity and for refractory overactive bladder, emerging clinical trials have demonstrated the benefits of BoNT-A treatment in functional urological disorders. Cautious selection of patients and urodynamic evaluation for confirmation of diagnosis are crucial to maximize the successful outcomes of BoNT-A treatment.

scholarly journals Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: The transurethral vs. transrectal approach

2015 ◽  
Vol 13 (2) ◽  
pp. 94-99 ◽  
Author(s):  
Mohamed A. El-enen ◽  
Mohamed Abou-Farha ◽  
Ahmed El-Abd ◽  
Hassan El-Tatawy ◽  
Ahmed Tawfik ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Botulinum Toxin A ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Toxin A

scholarly journals Botulinum Toxin-A Injection in Chronic Pelvic Pain Syndrome Treatment: A Systematic Review and Pooled Meta-Analysis

Toxins ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 25
Author(s):  
Andrea Panunzio ◽  
Alessandro Tafuri ◽  
Giovanni Mazzucato ◽  
Clara Cerrato ◽  
Rossella Orlando ◽  
...  
Keyword(s):  
Systematic Review ◽  
Botulinum Toxin ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Botulinum Toxin A ◽  
Meta Analysis ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Toxin A

Introduction: Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. The aim of this systematic review was to investigate the role of BTX-A in CPPS treatment. Methods: We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement in CPPS after BTX-A treatment. Pooled meta-analysis of the included studies, considering the effect of BTX-A on pain evaluated at last available follow-up compared to baseline values, was performed together with meta-regression analysis. Results: After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomized clinical trials and five comparative studies. They covered overall 896 patients of both sexes and several subtype of CPPS (interstitial cystitis/bladder pain syndrome, chronic prostatitis/prostate pain syndrome, chronic scrotal pain, gynecological pelvic pain, myofascial pelvic pain). The clinical and methodological heterogeneity of studies included makes it difficult to do an overall estimation of the real effect of BTX-A on pain and other functional outcomes of various CPPS subtypes. However, considering pooled meta-analysis results, a benefit in pain relief was showed for BTX-A-treated patients both in the overall studies populations and in the overall cohorts of patients with CPP due to bladder, prostate, and gynecological origin. Conclusions: BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.

scholarly journals Can Botulinum Toxin A Play a Role in Treatment of Chronic Pelvic Pain Syndrome in Female Patients?—Clinical and Animal Evidence

Toxins ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 110 ◽  
Author(s):  
Chin-Li Chen ◽  
En Meng
Keyword(s):  
Chronic Pain ◽  
Botulinum Toxin ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Botulinum Toxin A ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Toxin A ◽  
Bladder Pain

Chronic pelvic pain (CPP) is defined as chronic pain and inflammation in the pelvic organs for more than six months. There are wide ranges of clinical presentations, including pelvic pain, painful intercourse, irritable bowel syndrome, and pain during urinating. Chronic pelvic pain syndrome (CPPS) is a subdivision of CPP, and the pain syndrome may be focused within a single organ or more than one pelvic organ. As there is uncertain pathogenesis, no standard treatment is currently available for CPPS. Botulinum toxin A (BoNT-A) is a potent neurotoxin that blocks acetylcholine release to paralyze muscles. Intravesical BoNT-A injection can reduce bladder pain in patients with interstitial cystitis/bladder pain syndrome. BoNT-A injected into the pelvic floor muscles of women has also been reported to improve chronic pain syndrome. Due to the reversible effect of BoNT-A, repeated injection appears to be necessary and effective in reducing symptoms. Adverse effects of BoNT-A may worsen the preexisting conditions, including constipation, stress urinary incontinence, and fecal incontinence. This review summarizes the evidence of BoNT-A treatment for CPPS in animal studies and clinical studies regarding the therapeutic effects of BoNT-A for CPPS in female patients.

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