Botulinum Toxin A and Lower Urinary Tract Symptoms: Non Multa, Sed Multum (Not Many, But Much)

摘要

In early July 2008, the International Conference on Incontinence (ICI) was held in Paris, France, and in the final document, delegates confirmed that lower urinary tract symptoms (LUTS) are extremely distressing and have a significant negative impact on quality of life and health-care costs. It is now recognised that LUTS is a global term that encompasses all urinary symptoms, including storage, voiding, and postmicturition symptoms and sensory anomalies of the bladder . Management of the patient and drug treatment remain the main challenge for urologists, as an "epidemic" of subjects with LUTS, especially in the aging Western population, is expected by 2030 .At present, the primary pharmacologic treatment for detrusor overactivity (DO) and overactive bladder (OAB) consists of antimuscarinic agents. Objective clinical data, systematic reviews, and adjusted indirect comparisons confer a high level of evidence and strong recommendations for the use of old and new antimuscarinics . If it is true that antimuscarinic agents are the primary pharmacologic treatment for DO and OAB, caution should be exercised when evaluating and prescribing them or other drugs for LUTS. Attention should focus on the natural history of LUTS, choice of appropriate drug, treatment duration, restricted population, economic issues, high placebo response rates reported in clinical trials, diverse methods of outcome assessment, and, last but not least, patient expectations . Currently, many urologists aresearching for appropriate answers to these open questions and looking for more efficacious alternative drugs.