Approach to pharmacotherapy of botulinum toxin A in the field of urology

Hamid Mazdak, Zahra Tolou-Ghamari


By altering discharge of neurotransmitter from the end of nerve, the strong toxin that is called botulinum toxin or BTX could results in paralysis of different muscles into the human bodies.However there are seven serotype of botulinum toxin, but only botulimum toxin A (BTX-A) was recommended as the most commonly prescribed of BTX by urologists. When treatment strategy based on use of simultaneous anticholinergics could not meet a satisfactory criterion for pharmacologist, urologist and patients, then it seems that BTX-A expressively could improve urinary incontinence symptoms, urodynamic, and quality of life in patients with both neurogenic and non-neurogenic detrusor activity. Related to its use in urological disorders, it seems that intravesical BTX-A injection is useful in inflammatory bladder disease such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria and urinary retention could be mentioned as the maximum and minimum reported side-effects after injection. It is prescribed in urinary incontinence that could be a result of urethral underactivity (stress) or bladder overactivity (urge), or a combination of two urethral overactivity/bladder underactivity (overflow incontinence). Hematoma, pain at injection site, intractable headache, ptosis, diplopia and hyperactivity of the local antagonist muscle could be mentioned as the temporary side effects. Dry and red eye, space striving, dry mouth, abdominal turbulences, dysphagia, throatiness and lastly breathing difficulties could be specified as potentially serious events.


Botulinum toxin-A, BTX-A, urology, bladder, pharmacotherapy

Full Text:



Hambleton P. Clostridium botulinum toxins: a general review of involvement in disease, structure, mode of action and preparation for clinical use. J Neurol 239:16-20, 1992.

Omprakash HM, Rajendran SC. Botulinum Toxin Deaths: What is the Fact? J Cutan Aesthet Surg 1: 95-97, 2008.

Ginsberg D, Gousse A, Keppenne V, Sievert KD, Thompson C, Lam W, et al. Phase 3 efficacy and tolerability study of onabotulinum toxin A for urinary incontinence from neurogenic detrusor overactivity. J Urol 187:2131-2139, 2012.

Osman N, Mangera A, Hillary C, Inman R, Chapple C. The underactive bladder: detection and diagnosis. F1000Res. 2016 Jan 25;5. pii: F1000 Faculty Rev-102. doi: 10.12688/f1000research.7344.1. eCollection 2016.

Kim SH, Habashy D, Pathan S, Tse V, Collins R, Chan L. Eight-year experience with botulinum toxin type-A injections for the treatment of nonneurogenic overactive bladder: Are repeated injections worthwhile? Int Neurourol J 20:40-46, 2016.

Dhaked RK, Singh MK, Singh P, Gupta P. Botulinum toxin: Bioweapon and magic drug. Indian J Med Res 132:489-503, 2010.

Orasanu B, Sangeeta T. Mahajan. The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian J Urol 29:2-11. 2013.

Hasieh PF, Chiu HC, Chen KC, Chang CH, Chou ECL. Botulinum toxin A for the treatment of overactive bladder. Toxins 8:59:1-12, 2016.

Tolou-Ghamari Z, Mazdak H. Review of warfarin: A cytochrome P450 metabolizing drug, in clinical practice. Jentashapir J Health Res (in press): e32641, doi: 10.17795/jjhr-32641.

Tolou-Ghamari Z. Investigation of final causes of death in 5360 deceased patients within a teaching hospital in Isfahan, Iran. Am J Exp Clin Res 3:161-164, 2016.

Tolou-Ghamari Z. Efficacy and toxicity of rituximab in multiple sclerosis. Arch Neurosci 3:e30107, 2016.

Tolou-Ghamari Z, Palizban AA. Review of sodium valproate clinical and biochemical properties. Zahedan J Res Med Sci 17:e2207, 2015.

Chung E. Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions. Expert Opin Biol Ther 15:95-102, 2015.

Sahai A, Khan MS. Dasgupta P. Efficacy of botulinum toxin-A for treating idiopathic detrusor overactivity: Results from a single center, randomized, double-blind, placebo controlled trial. J Urol 177: 2231-2236, 2007.

Brubaker L, Richter H.E, Visco A, Mahajan S, Nygaard I, Braun T.M, Barber MD, Menefee S, Schaffer J, Weber A.M et al. Pelvic floor disorders network. Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol 180:217-222, 2008.

Dmochowski R, Chapple C, Nitti VW, Chancellor M, Everaert K, Thompson C, Daniell G, Zhou J, Haag-Molkenteller C. Efficacy and safety of onabotulinum toxin A for idiopathic overactive bladder: A double-blind, placebo controlled, randomized, dose ranging trial. J Urol 184:2416-2422, 2010.

Krivoborodov GG, Tur EI, Efremov NS. Injection of botulinum toxin type A in the bladder detrusor and submucosa in patients with overactive bladder without detrusor overactivity. Urologiia 2:31-34, 2015.

Jiang YH, Liao CH, Kuo HC. Current and potential urological applications of botulinum toxin A. Nat Rev Urol 12:519-533, 2015.

Petrou SP, Parker AS, JE Crook, Rogers A, Metz-Kudashik D, Theil DD. Botulinum A toxin/dimethyl sulfoxide bladder instillations for women with refractory idiopathic detrusor overactivity: A phase 1/2 study. Mayo Clin Proc 84:702-706, 2009.

Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev 12:CD005493, 2011.

Neuhaus J, Schwalenberg T. Intravesical treatments of bladder pain syndrome/interstitial cystitis. Nat Rev Urol 9:707-720, 2012.

Pinto R, Lopes T, Silva J, Silva C, Dinis P, Cruz F. Persistent therapeutic effect of repeated injections of onabotulinum toxin A in refractory bladder pain syndrome/interstitial cystitis. J Urol 189:548-553, 2013.

Abeywickrama L, Arunkalaivanan A, Quinlan M. Repeated botulinum toxin type A (Dysport) injections for women with intractable detrusor overactivity: a prospective outcome study. Int Urogynecol J 25:601-605, 2014.

Manning J, Dwyer P, Rosamilia A, Colyvas K, Murray C, Fitzgerald E. A multicentre, prospective, randomised, double-blind study to measure the treatment effectiveness of abobotulinum A (AboBTXA) among women with refractory interstitial cystitis/bladder pain syndrome. Int Urogynecol J 25:593-599, 2014.

Karsenty G, Denys P, Amarenco G, De Seze M, Gamé X, Haab F, et al. Botulinum toxin A (Botox)intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: A systematic literature review. Eur Urol 53:275-287, 2008.

Streeper NM, Nakada SY, Wertheim ML, Best SL. Preliminary evidence suggests periureteral botulinum toxin type A injection improves ureteral stone passage in the porcine model. J Endourol 30:327-331, 2016.

Shim SR, Cho YJ, Shin IS, Kim JH. Efficacy and safety of botulinum toxin injection for benign prostatic hyperplasia: a systematic review and meta-analysis. Int Urol Nephrol 48:19-30, 2016.

El-Enen MA, Abou-Farha M, El-Abd A, El-Tatawy H, Tawfik A, El-Abd S, Rashed M, El-Sharaby M. Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: The transurethral vs. transrectal approach. Arab J Urol 13:94-99, 2015.

Cui, Y.; Zhou, X.; Zong, H.; Yan, H.; Zhang, Y. The efficacy and safety of onabotulinumtoxinA in treating idiopathic OAB: A systematic review and meta-analysis. Neurourol Urodyn 34:413-419, 2015.

Jiang YH, Ong HL, Kuo HC. Predictive factors of adverse events after intravesical suburothelial onabotulinumtoxinA injections for overactive bladder syndrome-A real-life practice of 290 cases in a single center. Neurourol Urodyn 36:142-147, 2017.


  • There are currently no refbacks.