Using intravesical botulinum toxin as an adjunct during urologic surgery: a systematic review

Area of Science:

• Urology
• Surgical Innovation
• Pharmacological Adjuncts

Background:

• Intravesical onabotulinum toxin-A (BTX-A) is established for overactive bladder (OAB), neurogenic bladder, and interstitial cystitis.
• Limited evidence exists for BTX-A as an adjunct during urologic surgeries.
• The study aims to evaluate BTX-A's role in reducing bladder spasms and improving outcomes when used concurrently with urologic procedures.

Purpose of the Study:

• To examine the efficacy of adjunctive onabotulinum toxin-A (BTX-A) administered during urologic surgical procedures.
• To assess the impact of BTX-A on reducing bladder spasms, improving quality of life, and enhancing urinary outcomes post-surgery.

Main Methods:

• A comprehensive literature search was conducted across four major databases (MEDLINE, Embase, Cochrane Library, Web of Science).
• Included studies focused on adjunctive BTX-A use during urologic surgery, excluding its use as a standalone curative therapy or solely in the post-operative setting.
• Analysis prioritized studies reporting on quality of life and urinary function.

Main Results:

• Thirteen studies were included from 2175 initially identified.
• Adjunctive BTX-A in surgeries for benign prostatic hyperplasia and mid-urethral sling procedures demonstrated improved continence and reduced OAB/urgency incontinence symptoms.
• Use of BTX-A during bladder reconstruction and before fistula repair reduced pain, lower urinary tract symptoms, and bladder spasms, with no increased risk of urinary retention.

Conclusions:

• Preliminary evidence suggests that onabotulinum toxin-A (BTX-A) as an adjunct in urologic surgery can decrease bladder spasms and improve post-operative pain and continence.
• The use of BTX-A in this setting does not appear to elevate the risk of urinary retention.
• Further research is necessary to define the optimal indications and role of adjunctive BTX-A in urologic surgery.