Botulinum therapy in urology

Urge and rapid urination with urge urinary incontinence. Injections are performed into the detrusor during urethrocystoscopy using an endoscopic needle. The result is partial chemodenervation of the detrusor, which is manifested by a decrease in the number of urinations per day, episodes of urge urinary incontinence. As a rule, botulinum toxin injections are performed in patients with severe forms of overactive bladder, when other methods of treatment are not effective. This type of botulinum therapy provides good treatment results in a significant number of patients with forms of overactive bladder refractory to other treatments, namely neurogenic and idiopathic detrusor overactivity.

Botulinum toxin injections are performed into the transverse urethral sphincter to partially reduce or partially eliminate functional infravesical obstruction, which is manifested by restoration of independent urination or improvement in urine flow rate. Often it is possible to save patients from the need to perform periodic autocatheterization of the bladder or permanent drainage of the bladder with a urethral catheter or cystostomy drainage. Reduction of intraurethral resistance during urination after botulinum toxin injections into the transverse striated sphincter of the urethra is the prevention of vesicoureteral reflux, which is the main cause of decreased renal function and the development of chronic renal failure. In women, the transperineal method of drug administration into the urethral transverse striated sphincter is used under electromyography control, and in men – transurethral during urethrocystoscopy.

Until recently, the arsenal of urologists for the treatment of chronic pelvic pain syndrome included non-steroidal anti-inflammatory drugs, antidepressants, myorelaxants and other drugs, often provoking a number of side effects. Prolonged, often lifelong therapy, did not always yield positive results. There are three organs in the pelvis of women: bladder, uterus and rectum. They are “suspended” on a complex system of muscles and ligaments, which works as a whole. When a muscle is in a state of constant tension, the function of the organs is disturbed. Violations manifest themselves as pain in the perineum, lower abdomen, urethra or rectum. There is a vicious circle – hypertonicity causes pain syndrome, from which the already compressed muscle is compressed even more, provoking unbearable pain. Botolotoxin injections relax the muscle and relieve the spasm. After a couple of months, new nerve endings are formed in the injection area, and the pelvic organs begin to work normally. In men, injections are performed in the prostate gland, the transverse striated sphincter of the urethra, and in the pelvic floor muscles.

Injections of botulinum toxin into the prostate gland have also started to be used for this disease. As a result of injections, the volume of adenomatous nodes is reduced, which often leads to improved or restored urination.