Botulinum toxin has been used in urology since the end of the 1980s. However, this therapeutic option has not been firmly established yet. Valid studies have merely been conducted on detrusor sphincter dyssynergia (DSD) and on detrusor overactivity (hyperreflexia), but even those findings do not allow final conclusions. Success rates in DSD are between 58% and 88%, in detrusor overactivity approximately 80%. Further possible indications for botulinum toxin are motor and sensory urge, urethrospasm, spasticity of the pelvic floor, neobladder, and even chronic prostatic pain. To reach firmer conclusions, controlled studies with well-defined patient populations and using validated and reproducible outcome measures are needed. In addition, we also need information on repeated injections over a long period of time. These data are not available to date. At present, the application of botulinum toxin should be reserved for experienced users only.
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A 55-year-old female attended the Outpatient Urology Department for local anaesthetic flexible cystoscopy and intradetrusor botulinum toxin A injection. Having been diagnosed with urodynamics-proven low-grade detrusor overactivity in 2017, she was well-established on six-monthly Botox® injections. As part of her ongoing treatment, 100 units of Allergan Botox diluted with saline in a 10 mL syringe were injected via 20 punctures.
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