Use of botulinum toxin in the treatment of lower urinary tract disorders. Current status

The role of botulinum toxin in the treatment of lower urinary tract disorders has vastly expanded in the last few years. The indications list growing to include conditions ranging from detrusor sphincter dyssynergia, neurogenic and idiopathic detrusor overactivity, painful bladder syndrome and lower urinary tract symptoms consequent upon bladder outflow obstruction. This treatment is minimally invasive, shows a remarkable efficacy and has effects lasting up to one year. We review the latest evidence both basic science and clinical to address some of the key questions regarding this treatment modality. There is an abundance of evidence supporting the efficacy, safety and tolerability of this treatment. However, It is clear that much work is still required to understand the mechanism(s) of action of the toxin and more robust placebo controlled randomised trials need to be undertaken to answer the many remaining questions concerning this novel treatment. Nevertheless this treatment modality has remarkable efficacy and minimal side effects and thus will be a key future treatment option for a wide range of indications.