Injection of botulinum toxin type A in the urethral sphincter to treat lower urinary tract dysfunction: review of indications, techniques and results: 2011 update.

INTRODUCTION

The first application of botulinum toxin type A (BoNT-A) in urology was its injection into the urinary sphincter to treat neurogenic detrusor-sphincter dyssynergia (DSD) in quadriplegic men. Since that first report by Dyskatra et al in 1988, the results of focal BTA injections into the sphincter, the bladder wall and lately into the prostate have raised the interest of the urology community in this promising new therapeutic modality. This is an evidence-based review of the current indications, techniques and outcomes of BTA injections into the urethral sphincter.

MATERIALS AND METHODS

The Medline database was searched for the period between 1966 and October 2010, using the keywords 'botulinum toxin' and 'urethra' or 'urethral sphincter'. English written articles ere selected. A level of evidence according to the Oxford Centre for evidence-based medicine was assigned to each article.

CONCLUSION

Since our first review in 2006, very little has been added to the literature on the use of botulinum toxin injected into the external sphincter. At present, those most likely to benefit from intrasphincteric BTA injection are MS patients suffering the symptoms of DSD and quadriplegic men with DSD unable to perform self-catheterization. Well developed and conducted studies are necessary; these must be done urgently to better define the place and the results of this drug otherwise widely used in other indications in urology.