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Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where...
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Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 12024

Special Issue Editor

Prof. Dr. Hann-Chorng Kuo

E-Mail Website
Guest Editor
Department of Urology, Hualien Tzu Chi Hospital, Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Hualien, Taiwan
Interests: botulinum neurotoxin; neurourology; urodynamics; female urology; stress urinary; incontinence; LUTS
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Following on from the first Special Issue on the topic, “Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now?”

In recent decades, botulinum toxin A has been widely used in the treatment of several lower urinary tract dysfunctions (LUTDs), such as overactive bladder syndrome (OAB), neurogenic detrusor overactivity (NDO), interstitial cystitis (IC), and voiding dysfunction. Although botulinum toxin A intravesical injection has been approved for OAB and NDO, the other application of this neurotoxin in LUTDs is yet to be approved. Because some clinical experiences of adverse events have limited its wide application, this treatment has gradually been considered as an unpopular procedure for LUTDs. However, evidence has shown that botulinum toxin A has advantages in LUTDs compared with oral pharmacological medications, especially in elderly OAB patients with cognitive dysfunction, patients with bladder neck dysfunction or dysfunctional voiding, idiopathic voiding dysfunction due to poor relaxation of the external sphincter, or intractable bladder pain syndrome due to IC or ketamine-induced cystitis, male patients with lower urinary tract symptoms and a small prostate, and pediatric patients with OAB or dysfunctional voiding. In addition, botulinum toxin A can also be carried across the urothelial barrier with the aid of bladder treatment such as liposomes or low-energy shock waves. There are several LUTDs other than OAB and NDO that can benefit from botulinum toxin A injection or intravesical instillation. This Special Issue welcomes original or review articles that fucus on the novel applications of botulinum toxin A in LUTDs, either in human or animal studies. The collection of this Special Issue of Toxins will provide updated knowledge and information on the current position of botulinum toxin A in functional urology and LUTDs.

Prof. Dr. Hann-Chorng Kuo
Guest Editor

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Keywords

  • overactive bladder
  • interstitial cystitis
  • neurogenic detrusor overactivity
  • voiding dysfunction
  • lower urinary tract symptoms

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Published Papers (7 papers)

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12 pages, 239 KiB  
Article
Efficacy and Predictive Factors of Intravesical Botulinum Toxin A Injection for Treating Neurogenic Detrusor Overactivity in Children: A Single-Center Retrospective Study
by Chun-Kai Hsu, Han-Yu Lin, Stephen Shei-Dei Yang, Wan-Ling Young and Shu-Yu Wu
Toxins 2025, 17(4), 202; https://doi.org/10.3390/toxins17040202 - 17 Apr 2025
Viewed by 405
Abstract
Neurogenic detrusor overactivity (NDO) is a complex condition associated with detrusor overactivity, reduced bladder compliance, and high intravesical pressures, potentially leading to urinary tract infections (UTIs) and renal impairment. This retrospective study evaluated the safety and potential efficacy of intravesical botulinum toxin A [...] Read more.
Neurogenic detrusor overactivity (NDO) is a complex condition associated with detrusor overactivity, reduced bladder compliance, and high intravesical pressures, potentially leading to urinary tract infections (UTIs) and renal impairment. This retrospective study evaluated the safety and potential efficacy of intravesical botulinum toxin A (BoNT/A) injections in children with NDO at a single institution. Eighteen pediatric patients (median age: 8.1 years) were followed for a median of 6.3 years. At follow-up, 77.8% achieved a global response assessment (GRA) score of ≥2. A statistically significant improvement was found in cystometric bladder capacity (p = 0.041), but it did not remain significant after Bonferroni correction, while other urodynamic trends were not statistically significant. Adverse events were infrequent, with only 11.8% experiencing mild febrile UTIs. While some patients with poorer baseline bladder conditions reported greater subjective improvement, no statistically significant predictors of success were identified. Overall, intravesical BoNT/A injection appears to be a safe and potentially effective option for managing pediatric NDO, though larger prospective studies are needed to confirm these findings. Full article
(This article belongs to the Special Issue Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II)
11 pages, 374 KiB  
Article
The Effects of Botulinum Toxin A Injections on Patients with Radiogenic Lower Urinary Tract Symptoms
by Anke K. Jaekel, Ann-Christin Brüggemann, John Bitter, Franziska Knappe, Ruth Kirschner-Hermanns and Stephanie C. Knüpfer
Toxins 2025, 17(4), 200; https://doi.org/10.3390/toxins17040200 - 15 Apr 2025
Viewed by 390
Abstract
Botulinum toxin A (BTX-A) injection into the detrusor vesicae is an established therapy for neurogenic lower urinary tract dysfunction as well as idiopathic overactive bladder. Pelvic radiotherapy causes comparable lower urinary tract symptoms (LUTS) in a third of radiated patients. Little is known [...] Read more.
Botulinum toxin A (BTX-A) injection into the detrusor vesicae is an established therapy for neurogenic lower urinary tract dysfunction as well as idiopathic overactive bladder. Pelvic radiotherapy causes comparable lower urinary tract symptoms (LUTS) in a third of radiated patients. Little is known about the effects of BTX-A injections into the detrusor vesicae in the management of radiogenic LUTS. Our aim was to assess the effect of BTX A injections on these symptoms and related quality of life. Material and Methods: In total, 28 patients with BTX-A injections for radiogenic LUTS were assessed retrospectively. We analyzed symptoms recorded in bladder diaries, the results of quality-of-life questionnaires (ICIQ-LUTSqol), and urodynamic studies (UDS) before and after BTX-A injections. Results: A significant reduction in daily micturition frequency, nocturia, and pad consumption was demonstrated in the overall cohort and in gender-related subgroup analysis. There was a significant decrease in the ICIQ-LUTSqol independent of gender or BTX-A units. For UDS maximum cystometric bladder capacity (188.0 vs. 258.2 mL, p = 0.043), micturition volume (138.2 vs. 216.7 mL, p = 0.018), and first desire to void (98.2 vs. 171.2 mL, p = 0.042) was significantly improved. No side effects of the toxin injection or urinary retention were observed. Conclusions: Intradetrusor injection therapy with BTX-A could represent a safe and effective therapeutic option for radiogenic LUTS with increasing quality of life, reductions in symptoms, and the improvement of urodynamic parameters. Full article
(This article belongs to the Special Issue Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II)
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13 pages, 2076 KiB  
Article
Real-World Use of Intradetrusor Botulinum Toxin Injections: A Population-Based Study from France
by Alain Ruffion, Pierre Karam, Anne Forestier and Pierre Denys
Toxins 2024, 16(10), 423; https://doi.org/10.3390/toxins16100423 - 1 Oct 2024
Viewed by 1367
Abstract
In recent decades, intradetrusor injections of botulinum toxin A (BoNT-A) have been widely applied to treat incontinence in both idiopathic overactive bladder (iOAB) and neurogenic detrusor overactivity incontinence (NDOI). This analysis, based on the French National Hospital Discharge Database (PMSI), aims to describe [...] Read more.
In recent decades, intradetrusor injections of botulinum toxin A (BoNT-A) have been widely applied to treat incontinence in both idiopathic overactive bladder (iOAB) and neurogenic detrusor overactivity incontinence (NDOI). This analysis, based on the French National Hospital Discharge Database (PMSI), aims to describe real-world trends in intradetrusor BoNT-A use between 2014 and 2022. Among 32,864 patients who received at least one intradetrusor BoNT-A injection, 18,320 (55.7%) had conditions coded under iOAB, 13,376 (40.7%) under NDOI, and 1168 (3.6%) under other indications. The overall mean interval between two intradetrusor BoNT-A injections was 9.7 months, ranging from 8.7 months in patients with multiple sclerosis (MS) to 11.5 months in patients with cerebral pathologies. The median number of injections was two (quartile 1–quartile 3, 1–4) in patients with spina bifida, whereas it was five (2–10) in those with MS. Only 31% of patients with iOAB received more than two intradetrusor BoNT-A injections. Regardless of its indication, BoNT-A was well tolerated. Adverse events occurring during or requiring hospitalization included infections (3.8%), hematuria (0.53%), and bleeding episodes necessitating transfusions (0.11%), all recorded within the initial month following BoNT-A injection. Our analysis of the PMSI database highlights a broad spectrum of intradetrusor BoNT-A injection practices. Full article
(This article belongs to the Special Issue Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II)
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12 pages, 839 KiB  
Article
Intravesical Botulinum Toxin Injection Plus Hydrodistention Is More Effective in Patients with Bladder Pain-Predominant Interstitial Cystitis/Bladder Pain Syndrome
by Wan-Ru Yu, Jia-Fong Jhang and Hann-Chorng Kuo
Toxins 2024, 16(2), 74; https://doi.org/10.3390/toxins16020074 - 1 Feb 2024
Cited by 4 | Viewed by 2393
Abstract
Intravesical botulinum toxin A (BoNT-A) injections are included in the interstitial cystitis/bladder pain syndrome (IC/BPS) treatment guidelines. However, the IC phenotype suitable for treatment with BoNT-A has not been clarified. Therefore, we identified the factors influencing treatment outcomes for intravesical BoNT-A injections in [...] Read more.
Intravesical botulinum toxin A (BoNT-A) injections are included in the interstitial cystitis/bladder pain syndrome (IC/BPS) treatment guidelines. However, the IC phenotype suitable for treatment with BoNT-A has not been clarified. Therefore, we identified the factors influencing treatment outcomes for intravesical BoNT-A injections in patients with non-Hunner IC/BPS (NHIC). This retrospective study included patients with NHIC who underwent 100 U BoNT-A intravesical injections over the past two decades. Six months after treatment, treatment outcomes were assessed using the Global Response Assessment (GRA). Outcome endpoints included GRA, clinical symptoms, urodynamic parameters, urine biomarkers, and the identification of factors contributing to satisfactory treatment outcomes. The study included 220 patients with NHIC (42 men, 178 women). The satisfactory group (n = 96, 44%) had significantly higher pain severity scores and IC symptoms index, larger maximum bladder capacity (MBC), and lower 8-isoprostane levels at baseline. Logistic regression revealed that larger MBC (≥760 mL) and bladder pain predominance were associated with satisfactory outcomes after BoNT-A injection. Subjective parameters and pain severity scores improved significantly in patients with bladder pain-predominant IC/BPS after BoNT-A injection. Thus, NHIC patients with bladder or pelvic pain are more likely to experience satisfactory outcomes following intravesical BoNT-A injections. Full article
(This article belongs to the Special Issue Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II)
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29 pages, 401 KiB  
Article
Quality of Life in Female Patients with Overactive Bladder after Botulinum Toxin Treatment
by Agnieszka A. Licow-Kamińska, Sylwester M. Ciećwież, Magdalena Ptak, Dariusz Kotlęga and Agnieszka Brodowska
Toxins 2024, 16(1), 7; https://doi.org/10.3390/toxins16010007 - 21 Dec 2023
Viewed by 1981
Abstract
Background: Manifestations of OAB can considerably diminish the quality of life. Botulinum toxin has emerged as a valuable treatment option in diseases whose symptoms cannot be controlled adequately with other available therapies. The aim of the present study was to compare the subjective [...] Read more.
Background: Manifestations of OAB can considerably diminish the quality of life. Botulinum toxin has emerged as a valuable treatment option in diseases whose symptoms cannot be controlled adequately with other available therapies. The aim of the present study was to compare the subjective quality of life of patients with OAB before the injection of botulinum toxin and three and six months after the intervention. Methods: This study was based on a diagnostic survey with three validated questionnaires, ICIQ-OAB, ICIQ-OABqol, and ICIQ-LUTSqol, and an additional questionnaire developed by the authors to collect sociodemographic characteristics and selected medical data. Results: This study demonstrated significant differences between pre-treatment scores and those at three and six months post injection. At three and six months after the intervention, mean scores for all three instruments (ICIQ-OAB, ICIQ-OABqol, ICIQ-LUTSqol) were significantly lower than the respective pre-treatment values, implying a significant attenuation of OAB symptoms and their lower impact on the quality of life. However, the severity of OAB symptoms and their impact on the quality of life at six months post intervention were significantly higher than at three months, except for the social interaction domain. Conclusions: Botulinum toxin is an effective treatment for OAB. Full article
(This article belongs to the Special Issue Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II)
14 pages, 1483 KiB  
Article
Retrospective Observational Study of Treatment Patterns and Efficacy of onabotulinumtoxinA Therapy in Patients with Refractory Overactive Bladder in Clinical Practice
by Kwang Jin Ko and Kyu-Sung Lee
Toxins 2023, 15(5), 338; https://doi.org/10.3390/toxins15050338 - 15 May 2023
Cited by 1 | Viewed by 1909
Abstract
This study aimed to evaluate the treatment patterns and long-term efficacy of onabotulinumtoxinA injections in a clinical setting. This single-center retrospective study was conducted on patients with refractory overactive bladder (OAB) aged 18 years or older who received onabotulinumtoxinA 100 IU administered between [...] Read more.
This study aimed to evaluate the treatment patterns and long-term efficacy of onabotulinumtoxinA injections in a clinical setting. This single-center retrospective study was conducted on patients with refractory overactive bladder (OAB) aged 18 years or older who received onabotulinumtoxinA 100 IU administered between April 2012 and May 2022. The primary endpoint was the treatment pattern, including the retreatment rate and OAB medication prescription pattern. The duration and effectiveness of onabotulinumtoxinA treatment were analyzed using the overactive bladder symptom score and voiding diaries. A total of 216 patients were enrolled in this study, and the overall patient satisfaction rate was 55.1%. After the first injection, 19.9% received a second treatment, and 6.1% received three or more injections. The median duration until the second injection was 10.7 months. Among the patients, 51.4% resumed OAB medications after 2.96 months. The presence of urodynamic detrusor overactivity was observed only in female patients (odds ratio, 23.65; 95% CI, 1.84 to 304.40), which was associated with a good response. In contrast to clinical trials, the degree of improvement and retreatment rate did not meet expectations. Our findings provide valuable insights into the effectiveness of onabotulinumtoxinA injections in patients with refractory OAB symptoms in real-world practice. Full article
(This article belongs to the Special Issue Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II)
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17 pages, 3982 KiB  
Systematic Review
Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials
by Yu-Hsuan Chen, Jen-Hao Kuo, Yen-Ta Huang, Pei-Chun Lai, Yin-Chien Ou and Yu-Ching Lin
Toxins 2024, 16(11), 484; https://doi.org/10.3390/toxins16110484 - 8 Nov 2024
Viewed by 2191
Abstract
Overactive bladder (OAB) significantly impairs quality of life in the elderly. Although the intradetrusor injection of botulinum toxin type A (BoNT-A) is a treatment option, its effects on older adults remain uncertain. This study aimed to evaluate the efficacy and safety of BoNT-A [...] Read more.
Overactive bladder (OAB) significantly impairs quality of life in the elderly. Although the intradetrusor injection of botulinum toxin type A (BoNT-A) is a treatment option, its effects on older adults remain uncertain. This study aimed to evaluate the efficacy and safety of BoNT-A intradetrusor injections in elderly OAB patients through a systematic review and meta-analysis. A comprehensive literature search was conducted using the PubMed, Embase, Cochrane Library, Scopus, and CINAHL databases from inception to 30 May 2024. The primary outcomes were improvements in daily urinary incontinence (UI) episodes and patient-reported outcomes, while the secondary outcomes focused on potential adverse events. Four randomized controlled trials with 803 participants were included. BoNT-A injections significantly reduced daily UI episodes at 4–6 weeks (mean difference [MD]: −3.82; 95% confidence interval [CI]: −6.29 to −1.35) and at 12 weeks (MD: −2.17; 95% CI: −3.22 to −1.12). However, BoNT-A was associated with an increased risk of elevated post-void residual (Risk Difference [RD]: 0.154; 95% CI: 0.058 to 0.251) and urinary tract infection (RD: 0.111; 95% CI: 0.005 to 0.217), with no significant difference observed in the initiation of catheterization or hematuria. Trial sequential analysis confirmed a sufficient sample size and statistical power. In conclusion, while BoNT-A effectively manages OAB in the elderly, careful post-injection monitoring is warranted due to its potential risks. Full article
(This article belongs to the Special Issue Application of Botulinum Neurotoxin in Lower Urinary Tract Dysfunctions: Where Are We Now? II)
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