Botulinum toxins (BT) are one of the most powerful
poisons in nature. They are responsible for human
botulism and constitute a potential chemical weapon, but can also be used as a therapeutic agent. Sphincter, bladder and prostatic
injections have been described in urological indications as varied as detrusor-sphincter
dyssynergia and neurogenic detrusor hyperactivity, idiopathic
overactive bladder symptoms,
interstitial cystitis, obstructive voiding disorders related to
benign prostatic hyperplasia or chronic
prostatitis, and recurrent
urethral stricture. This review of the literature presents the results and level of evicence in support of the use of BT in urological indications. Detrusor
injections of BT-A constitute an alternative
conservative treatment that is effective in the short term (6-12 months) after failure of
anticholinergic agents to treat neurogenic detrusor hyperactivity (level 1b). Sphincter
injections are effective in the short-term treatment of neurogenic detrusor-sphincter
dyssynergia (level 1c). The efficacy observed during preliminary clinical trials of detrusor
injections of BT-A for idiopathic
overactive bladder symptoms or
interstitial cystitis (level 4) and prostatic
injections for obstruction related to BPH (level 1c) justifies the major interest raised by this new therapeutic approach. However, these preliminary results must be confirmed by comparative studies on a sufficient number of patients with long-term follow-up before considering the use of this technique in routine clinical practice.