Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan.
Department of Chemistry, Fu Jen Catholic University, New Taipei City 24205, Taiwan.
Toxins (Basel). 2020 Feb 18;12(2):129. doi: 10.3390/toxins12020129.
Intravesical botulinum toxin (BoNT) injection is effective in reducing urgency and urinary incontinence. It temporarily inhibits the detrusor muscle contraction by blocking the release of acetylcholine (Ach) from the preganglionic and postganglionic nerves in the efferent nerves. BoNT-A also blocks ATP release from purinergic efferent nerves in the detrusor muscle. In afferent nerves, BoNT-A injection markedly reduces the urothelial ATP release and increases nitric oxide (NO) release from the urothelium. BoNT-A injection in the urethra or bladder has been developed in the past few decades as the treatment method for detrusor sphincter dyssyndergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders, including bladder hypersensitivity, overactive bladder, and interstitial cystitis/chronic pelvic pain syndrome. Although the FDA only approved BoNT-A injection treatment for neurogenic detrusor overactivity and for refractory overactive bladder, emerging clinical trials have demonstrated the benefits of BoNT-A treatment in functional urological disorders. Cautious selection of patients and urodynamic evaluation for confirmation of diagnosis are crucial to maximize the successful outcomes of BoNT-A treatment.
膀胱内肉毒毒素（BoNT）注射可有效减少尿急和尿失禁。它通过阻断传出神经节前和节后神经中乙酰胆碱（Ach）的释放来暂时抑制逼尿肌收缩。BoNT-A 还可阻断逼尿肌中嘌呤能传出神经的 ATP 释放。在传入神经中，BoNT-A 注射可显著减少尿路上皮的 ATP 释放，并增加一氧化氮（NO）从尿路上皮释放。在过去几十年中，尿道或膀胱内 BoNT-A 注射已作为逼尿肌括约肌协同失调、神经源性或特发性逼尿肌过度活动引起的失禁、感觉障碍（包括膀胱过度敏感、膀胱过度活动症和间质性膀胱炎/慢性骨盆疼痛综合征）的治疗方法得到发展。尽管 FDA 仅批准 BoNT-A 注射治疗神经源性逼尿肌过度活动和难治性膀胱过度活动症，但新兴的临床试验已经证明了 BoNT-A 治疗在功能性泌尿科疾病中的益处。谨慎选择患者和尿动力学评估以确认诊断对于最大限度地提高 BoNT-A 治疗的成功结果至关重要。
