Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Repeat botulinum toxin-A injections for treatment of adult detrusor overactivity

Nature Reviews Urology volume 7, pages 661–667 (2010)Cite this article

Subjects

Abstract

Intravesical injections of botulinum toxin-A have become established as an effective therapy in the management of neurogenic and idiopathic detrusor overactivity that is refractory to treatment with anticholinergic medication. The effects of the toxin are finite and repeated injections are required to sustain the beneficial therapeutic effects. The available data suggest a reproducible and sustained improvement in symptoms as well as urodynamic parameters following repeated injections of botulinum toxin-A. The reported incidence of adverse events is low and resistance to the toxin is uncommon. The timing of repeat injections within the published data is variable, reflecting differing practise among clinicians, but is typically 6–12 months. Larger scale studies are still required to clarify the usefulness of botulinum toxin-A as a long-term treatment in the management of detrusor overactivity.

Key Points

  • Repeated intradetrusor injections of botulinum toxin-A are being used as a long-term management strategy for some patients with detrusor overactivity

  • Repeated injections of botulinum toxin-A can maintain the symptomatic improvement derived from the initial treatment in many patients with neurogenic or idiopathic detrusor overactivity

  • The incidence of serious adverse events such as weakness distant from the site of injection seems to be low

  • Reported rates of treatment failure following repeated injections seem to be low, although current data are short term and incomplete

  • Re-injection is generally at the request of the patient, although in some patients adverse cystometric changes can be used as criteria for re-treatment

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Apostolidis, A. et al. Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions: A European consensus report. Eur. Urol. 55, 100–120 (2009).

    Article  CAS  PubMed  Google Scholar 

  2. Grosse, J., Kramer, G. & Stohrer, M. Success of repeat detrusor injections of botulinum a toxin in patients with severe neurogenic detrusor overactivity and incontinence. Eur. Urol. 47, 653–659 (2005).

    Article  CAS  PubMed  Google Scholar 

  3. Karsenty, G., Reitz, A., Lindemann, G., Boy, S. & Schurch, B. Persistence of therapeutic effect after repeated injections of botulinum toxin type A to treat incontinence due to neurogenic detrusor overactivity. Urology 68, 1193–1197 (2006).

    Article  PubMed  Google Scholar 

  4. Akbar, M. et al. Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction. BJU Int. 100, 639–645 (2007).

    Article  PubMed  Google Scholar 

  5. Kalsi, V. et al. Botulinum injections for the treatment of bladder symptoms of multiple sclerosis. Ann. Neurol. 62, 452–457 (2007).

    Article  CAS  PubMed  Google Scholar 

  6. Reitz, A. et al. Do repeat intradetrusor botulinum toxin type a injections yield valuable results? Clinical and urodynamic results after five injections in patients with neurogenic detrusor overactivity. Eur. Urol. 52, 1729–1735 (2007).

    Article  PubMed  Google Scholar 

  7. Del, P. G. et al. Neurogenic detrusor overactivity treated with English botulinum toxin a: 8-year experience of one single centre. Eur. Urol. 53, 1013–1019 (2008).

    Article  Google Scholar 

  8. Giannantoni, A., Mearini, E., Del, Z. M. & Porena, M. Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity: clinical and urodynamic results. Eur. Urol. 55, 705–711 (2009).

    Article  CAS  PubMed  Google Scholar 

  9. Ghalayini, I. F., Al-Ghazo, M. A. & Elnasser, Z. A. Is efficacy of repeated intradetrusor botulinum toxin type A (Dysport®) injections dose dependent? Clinical and urodynamic results after four injections in patients with drug-resistant neurogenic detrusor overactivity. Int. Urol. Nephrol. 41, 805–813 (2009).

    Article  CAS  PubMed  Google Scholar 

  10. Pannek, J., Gocking, K. & Bersch, U. Long-term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction. BJU Int. 104, 1246–1250 (2009).

    Article  CAS  PubMed  Google Scholar 

  11. Sahai, A., Dowson, C., Khan, M. S. & Dasgupta, P. Repeated injections of botulinum toxin-A for idiopathic detrusor overactivity. Urology 75, 552–558 (2010).

    Article  PubMed  Google Scholar 

  12. Khan, S. et al. What a patient with refractory idiopathic detrusor overactivity should know about botulinum neurotoxin type A injection. J. Urol. 181, 1773–1778 (2009).

    Article  CAS  PubMed  Google Scholar 

  13. Kuschel, S., Werner, M., Schmid, D. M., Faust, E. & Schuessler, B. Botulinum toxin-A for idiopathic overactivity of the vesical detrusor: a 2-year follow-up. Int. Urogynecol. J. Pelvic Floor Dysfunct. 19, 905–909 (2008).

    Article  PubMed  Google Scholar 

  14. Mehnert, U. et al. A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging. World J. Urol. 27, 397–403 (2009).

    Article  CAS  PubMed  Google Scholar 

  15. Antonucci, F., Rossi, C., Gianfranceschi, L., Rossetto, O. & Caleo, M. Long-distance retrograde effects of botulinum neurotoxin A. J. Neurosci. 28, 3689–3696 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Apostolidis, A. et al. Histological changes in the urothelium and suburothelium of human overactive bladder following intradetrusor injections of botulinum neurotoxin type A for the treatment of neurogenic or idiopathic detrusor overactivity. Eur. Urol. 53, 1245–1253 (2008).

    Article  CAS  PubMed  Google Scholar 

  17. Comperat, E. et al. Histologic features in the urinary bladder wall affected from neurogenic overactivity--a comparison of inflammation, oedema and fibrosis with and without injection of botulinum toxin type A. Eur. Urol. 50, 1058–1064 (2006).

    Article  CAS  PubMed  Google Scholar 

  18. Schulte-Baukloh, H. et al. Botulinum neurotoxin type A in urology: antibodies as a cause of therapy failure. Int. J. Urol. 15, 407–415 (2008).

    Article  CAS  PubMed  Google Scholar 

  19. Anderson, T. J. et al. Botulinum toxin treatment of spasmodic torticollis. J. R. Soc. Med. 85, 524–529 (1992).

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Greene, P., Fahn, S. & Diamond, B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov. Disord. 9, 213–217 (1994).

    Article  CAS  PubMed  Google Scholar 

  21. Jankovic, J. & Schwartz, K. Response and immunoresistance to botulinum toxin injections. Neurology 45, 1743–1746 (1995).

    Article  CAS  PubMed  Google Scholar 

  22. Zuber, M., Sebald, M., Bathien, N., de Recondo, J. & Rondot, P. Botulinum antibodies in dystonic patients treated with type A botulinum toxin: frequency and significance. Neurology 43, 1715–1718 (1993).

    Article  CAS  PubMed  Google Scholar 

  23. Jankovic, J., Vuong, K. D. & Ahsan, J. Comparison of efficacy and immunogenicity of original versus current botulinum toxin in cervical dystonia. Neurology 60, 1186–1188 (2003).

    Article  CAS  PubMed  Google Scholar 

  24. Dressler, D. & Adib, S. F. New formulation of Botox: complete antibody-induced treatment failure in cervical dystonia. J. Neurol. Neurosurg. Psychiatry 78, 108–109 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Dressler, D. Clinical presentation and management of antibody-induced failure of botulinum toxin therapy. Mov. Disord. 19 (Suppl. 8), S92–S100 (2004).

    Article  PubMed  Google Scholar 

  26. Sangster, P. et al. Is the Extensor digitorum brevis test useful in predicting resistance to treatment with botulinum toxin-A for patients with overactive bladder [abstract MP23-04]? J. Endourol. 23 (Suppl. 1), 74 (2009).

    Google Scholar 

  27. Dressler, D. & Bigalke, H. Antibody-induced failure of botulinum toxin type B therapy in de novo patients. Eur. Neurol. 52, 132–135 (2004).

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are writing on behalf of the GKT Botulinum Study group, and would like to thank the Urology Foundation, and Kamran Ahmed for his help with this Review. P. Dasgupta and A. Sahai acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. They also acknowledge the support of the MRC Centre for Transplantation.

Author information

Authors and Affiliations

  1. Department of Urology, Medical Research Council (MRC) Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK

    Christopher Dowson, Mohammad Shamim Khan, Prokar Dasgupta & Arun Sahai

Authors
  1. Christopher Dowson
    View author publications

    Search author on:PubMed Google Scholar

  2. Mohammad Shamim Khan
    View author publications

    Search author on:PubMed Google Scholar

  3. Prokar Dasgupta
    View author publications

    Search author on:PubMed Google Scholar

  4. Arun Sahai
    View author publications

    Search author on:PubMed Google Scholar

Contributions

C. Dowson and A. Sahai researched data for, and wrote, the article. All authors were involved in the discussions of content and review/editing of the manuscript before submission. P. Dasgupta, M. S. Khan and A. Sahai reviewed and edited the article before submission.

Corresponding author

Correspondence to Arun Sahai.

Ethics declarations

Competing interests

The authors declare an association with Allergan Ltd: Grant support (all authors), Consultant (P. Dasgupta), Speakers bureau (honoraria) (A. Sahai).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dowson, C., Khan, M., Dasgupta, P. et al. Repeat botulinum toxin-A injections for treatment of adult detrusor overactivity. Nat Rev Urol 7, 661–667 (2010). https://doi.org/10.1038/nrurol.2010.187

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/nrurol.2010.187

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing