In the “Botox as Pharmacomodulation” session the presentation on Botulinum Toxin payment Lower Urinary Plot Dysfunction: Injection Techniques was given by Victor, Nitti, MD. The cynosure clear of the image was the techniques in using botulinum toxin injections into the detrusor. Dr. Nitti remarked that this usage of Botox is not approved by the FDA. Botulinum toxin injections directly into the detrusor suffer with been tempered to recompense over six years. There is a body of trace for the duration of the efficacy in both neurogenic and non-neurogenic detrusor overactivity. The optimal dose, concentration and injection templates have not been precise. Further, there are a number of different toxins (serotypes and preparations) and the units of one product are not equivalent to another type. He also pointed out that conversion formulas may not be accurate. There are two types of botulinum toxin-A, Botox® and Dysport® and the total of units varies significantly between these two products as agreeable.
Most published reports have used the Botox® preparation (Allergan) to behave detrusor overactivity. The units used play a joke on been unstable between 100 and 300 units; however there is unimportant comparative data in the literature. The multi-centered, randomized, double-0blind, placebo controlled on by Schurch et al, (J. Urol. 2005;174: 196-200) both 200 and 300 units of Botox® each demonstrated to be significantly better than placebo in treating neurogenic detrusor overactivity, however the examine was not powered to compare the two doses.
Dr. Nitti explained that a sprinkling contrasting concentrations of Botox have been sued from 100 units in 1 mL normal saline to 100 units in 10 mL. 100 units/10 mL is the most regular dilution used in the published trials.
Further the optimal numbers and location of injections has not been determined. Several different injection templates have been described including lateral and hind walls, lateral and posterior walls gain the trigone and the trigone only. The toxin can be injected using either a rigid or flexible cystoscope. There was talk on preferences, and it seems to be physician selection with a view each patient.
It was down from the participants that diverse cause circumstance using botulinum toxin in the treatment of detrusor overactivity and other lower urinary tract dysfunction and that as a greater understanding of the treatment advantages emanate from the clinical pamphlets it is being adopted in patients with detrusor overactivity that have in the offing few if any other options.
By Roger Dmochowski, MD
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