The current standing of intramural injection of botulinum neurotoxin in managing the overactive bladder.

摘要

The current practice in managing overactive bladder and detrusor overactivity (DO) is based on conservative measures and antimuscarinic drugs, but a significant minority are refractory to treatment. Where the effect on quality of life is severe and the patient is willing to face risks, augmentation cystoplasty, detrusor myectomy or urinary diversion may be considered. However, there are many for whom simple measures are inadequate, but who are not in a position to proceed to major surgery. This discrepancy between the extreme ends of the treatment spectrum is a substantial drawback. Intravesical botulinum treatment has been hailed as a potential saviour in this regard. Nonetheless, it is important to remember that the procedure is as yet unlicensed. Furthermore, there is no consensus regarding-bptimal dosing and administration regimes. We therefore do need to maintain caution, with specific patient counselling regarding the absence of long-term evidence.