Ten years single surgeon experience with botulinum toxin in the urinary tract; clinical observations and research discovery

This review details a single surgeon's 10-year experience with botulinum toxin (BoNT) for lower urinary tract symptoms (LUTS). Review of author's published clinical and research experience with BoNT in the prostate, bladder and urethral sphincter. Key observations include that an approximate 90% decrease is needed for bladder augmentation and reconstruction. Detrusor compliance and vesicoureteral reflux improved in over 50% of patients. Submucosal and trigone injection had similar efficacy with low rate of retention that can benefit patients with sensory urgency. No case of clinical vesicoureteral reflux has been noted with trigone injection technique. Dose of less than 200 U are clinically beneficial with duration of efficacy increasing with subsequent BoNT injection that may result in improved health economics benefits. Symptom improvement commonly lasts no less than 12 months with prostate injection. Experiment evidences that BoNT blocks sensory neurotransmitter release that has correlated with benefits seen in patients with bladder pain and abacterial prostatitis. Similar efficacy is observed in refractory overactive bladder as with neurogenic and idiopathic detrusor overactivity. BoNT is promising for a variety of LUTS in author's personal experience over the past 10 years with research that advanced our understanding of BoNT mechanisms of action in the sensory nerves and prostate gland. International multicenter randomized trials for bladder and prostate indications are currently ongoing seeking regulatory approval.