The pharmacologic treatment of
overactive bladder and detrusor overactivity, whether idiopathic or neurogenic, has centered around blocking
muscarinic receptors on the detrusor muscle. Although newer agents have been developed with better tolerability and safety, the basic mechanism by which the "irritable" detrusor is treated has not changed in decades. Although effective in many cases of idiopathic and neurogenic detrusor overactivity and
overactive bladder,
antimuscarinic agents fall short in many other cases because of lack of efficacy and/or tolerability. For the past several years, there has been increasing evidence to support the use of
botulinum toxin for the treatment of detrusor overactivity and
overactive bladder syndrome not effectively treated by
anticholinergics. From early open-label studies to the more recent randomized, controlled trials, efficacy and tolerability data have been very encouraging.
Botulinum toxin is not yet approved by the US Food and Drug Administration for the treatment of detrusor overactivity and
overactive bladder, but the positive results seen thus far cannot be ignored.