Intravesical Injection of Botulinum Toxin Type A in Men Without Bladder Outlet Obstruction and Post-Deobstructive Prostate Surgery

Overview

Journal Toxins (Basel)

Publisher MDPI

Specialty Toxicology

Date 2023 Mar 28

PMID 36977112

Authors

Hsiang-Ying Lee

Hann-Chorng Kuo

Affiliations

Soon will be listed here.

Abstract

Purpose: A significant proportion of men without bladder outlet obstruction (BOO) have been reported to have overactive bladders (OAB). This article aimed to review the specific group of reports on the use of botulinum toxin type A (BTX-A) injections into the bladder wall.

Materials And Methods: Original articles reporting men with small prostates without BOO were identified through a literature search using the PubMed and EMBASE databases. Finally, we included 18 articles that reviewed the efficacy and adverse effects of BTX-A injections in men.

Results: Of the 18 articles screened, 13 demonstrated the therapeutic efficacy and adverse effects of BTX-A injections in men. Three studies compared BTX-A injection response between patients without prior prostate surgery and those undergoing prior prostate surgery, including transurethral resection of the prostate and radical prostatectomy (RP). Patients with prior RP experienced better efficacy and had a low risk of side effects. Two studies focused on patients who had undergone prior surgery for stress urinary incontinence, including male sling and artificial urethral sphincter surgery. The BTX-A injection was a safe and effective procedure for this specific group. OAB in men was found to have a different pathophysiology mechanism from that in female patients, which may decrease the efficacy of BTX-A injection in men. However, patients with small prostates and low prostate-specific antigen levels demonstrated better efficacy and tolerability after BTX-A injection.

Conclusions: Although intravesical injection of BTX-A was a good option for controlling refractory OAB in men, the evidence-based guidelines are still limited. Further research is necessary to better understand the role of BTX-A injections on various aspects and histories. Therefore, treating patients using strategies tailored to their individual conditions is important.

Citing Articles

The Esthetic Use of Botulinum Toxins in Cancer Patients: Providing a Foundation for Future Indications.

Papagni M, Renga M, Mogavero S, Veronesi P, Cavallini M Toxins (Basel). 2025; 17(1).

PMID: 39852984 PMC: 11769536. DOI: 10.3390/toxins17010031.

Review of simultaneous treatment with intradetrusor onabotulinumtoxinA injections during transurethral prostate surgery for men with bladder outlet obstruction and overactive bladder.

Hsu C, Young W, Wu S Tzu Chi Med J. 2025; 37(1):42-48.

PMID: 39850386 PMC: 11753517. DOI: 10.4103/tcmj.tcmj_180_24.

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A.

Kuo H Tzu Chi Med J. 2024; 36(3):260-270.

PMID: 38993829 PMC: 11236072. DOI: 10.4103/tcmj.tcmj_29_24.

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions.

Jiang Y, Jhang J, Chen S, Kuo H Toxins (Basel). 2024; 16(3).

PMID: 38535789 PMC: 10975819. DOI: 10.3390/toxins16030123.

References

Manohar C, Rajawat M, Keshavamurthy R, Chouhan P, Poonawala A . Urodynamic profile of lower urinary tract symptoms in young men: A testimony of the truth?. Urol Ann. 2022; 14(3):215-217. PMC: 9472317. DOI: 10.4103/ua.ua_9_21. View

Irwin D, Milsom I, Kopp Z, Abrams P, Artibani W, Herschorn S . Prevalence, severity, and symptom bother of lower urinary tract symptoms among men in the EPIC study: impact of overactive bladder. Eur Urol. 2009; 56(1):14-20. DOI: 10.1016/j.eururo.2009.02.026. View

Rahnamai M, Marcelissen T, Brierley B, Schurch B, de Vries P . Long-term compliance and results of intravesical botulinum toxin A injections in male patients. Neurourol Urodyn. 2017; 36(7):1855-1859. DOI: 10.1002/nau.23196. View

Jambusaria L, Dmochowski R . Intradetrusor onabotulinumtoxinA for overactive bladder. Expert Opin Biol Ther. 2014; 14(5):721-7. DOI: 10.1517/14712598.2014.897322. View

Yokoyama O, Honda M, Yamanishi T, Sekiguchi Y, Fujii K, Kinoshita K . Efficacy and safety of onabotulinumtoxinA in patients with overactive bladder: subgroup analyses by sex and by serum prostate-specific antigen levels in men from a randomized controlled trial. Int Urol Nephrol. 2021; 53(11):2243-2250. PMC: 8494701. DOI: 10.1007/s11255-021-02962-z. View

Osborn D, Kaufman M, Mock S, Guan M, Dmochowski R, Reynolds W . Urinary retention rates after intravesical onabotulinumtoxinA injection for idiopathic overactive bladder in clinical practice and predictors of this outcome. Neurourol Urodyn. 2014; 34(7):675-8. PMC: 4755310. DOI: 10.1002/nau.22642. View

Hsiao S, Lin H, Kuo H . Urodynamic prognostic factors for large post-void residual urine volume after intravesical injection of onabotulinumtoxinA for overactive bladder. Sci Rep. 2017; 7:43753. PMC: 5338319. DOI: 10.1038/srep43753. View

El-Hefnawy A, Elbaset M, Taha D, Wadie B, Kenawy M, Shokeir A . Trigonal-sparing versus trigonal-involved Botox injection for treatment of idiopathic overactive bladder: A randomized clinical trial. Low Urin Tract Symptoms. 2020; 13(1):22-30. DOI: 10.1111/luts.12321. View

Karsenty G, Elzayat E, Delapparent T, St-Denis B, Lemieux M, Corcos J . Botulinum toxin type a injections into the trigone to treat idiopathic overactive bladder do not induce vesicoureteral reflux. J Urol. 2007; 177(3):1011-4. DOI: 10.1016/j.juro.2006.10.047. View

10.

Wang C, Chou E, Chuang Y, Lin C, Hsu Y, Liao C . Effectiveness and Safety of Intradetrusor OnabotulinumtoxinA Injection for Neurogenic Detrusor Overactivity and Overactive Bladder Patients in Taiwan-A Phase IV Prospective, Interventional, Multiple-Center Study (Restore Study). Toxins (Basel). 2021; 13(12). PMC: 8707051. DOI: 10.3390/toxins13120911. View

11.

Verhovsky G, Baberashvili I, Rappaport Y, Zilberman D, Neheman A, Gal J . Bladder Oversensitivity Is Associated with Bladder Outlet Obstruction in Men. J Pers Med. 2022; 12(10). PMC: 9605007. DOI: 10.3390/jpm12101675. View

12.

Bels J, de Vries P, de Beij J, Marcelissen T, Van Koeveringe G, Rademakers K . Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery. Eur Urol Focus. 2020; 7(6):1424-1429. DOI: 10.1016/j.euf.2020.08.015. View

13.

Grishin A, Spaska A, Kayumova L . Correction of overactive bladder with botulinum toxin type A (BTX-A). Toxicon. 2021; 200:96-101. DOI: 10.1016/j.toxicon.2021.07.005. View

14.

Dowson C, Watkins J, Khan M, Dasgupta P, Sahai A . Repeated botulinum toxin type A injections for refractory overactive bladder: medium-term outcomes, safety profile, and discontinuation rates. Eur Urol. 2011; 61(4):834-9. DOI: 10.1016/j.eururo.2011.12.011. View

15.

Roehrborn C, Kaplan S, Kraus S, Wang J, Bavendam T, Guan Z . Effects of serum PSA on efficacy of tolterodine extended release with or without tamsulosin in men with LUTS, including OAB. Urology. 2008; 72(5):1061-7. DOI: 10.1016/j.urology.2008.06.067. View

16.

Roehrborn C, Kaplan S, Stephen Jones J, Wang J, Bavendam T, Guan Z . Tolterodine extended release with or without tamsulosin in men with lower urinary tract symptoms including overactive bladder symptoms: effects of prostate size. Eur Urol. 2008; 55(2):472-9. DOI: 10.1016/j.eururo.2008.06.032. View

17.

Abdelwahab O, Sherif H, Soliman T, Elbarky I, Eshazly A . Efficacy of botulinum toxin type A 100 Units versus 200 units for treatment of refractory idiopathic overactive bladder. Int Braz J Urol. 2016; 41(6):1132-40. PMC: 4756939. DOI: 10.1590/S1677-5538.IBJU.2014.0221. View

18.

Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford A, Davis J . Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol. 2005; 174(3):977-82. DOI: 10.1097/01.ju.0000169481.42259.54. View

19.

Ashok K, Wang A . Detrusor overactivity: an overview. Arch Gynecol Obstet. 2010; 282(1):33-41. DOI: 10.1007/s00404-010-1407-3. View

20.

Abrar M, Stroman L, Malde S, Solomon E, Sahai A . Predictors of Poor Response and Adverse Events Following Botulinum Toxin-A for Refractory Idiopathic Overactive Bladder. Urology. 2019; 135:32-37. DOI: 10.1016/j.urology.2019.08.054. View