Botulinum neurotoxin (BoNT) is a neurotoxic protein produced by Clostridium botulinum (gram-positive bacillus) and other clostridia species. It blocks the release of acetylcholine from nerve endings at the neuromuscular junction, thereby causing paralysis. The toxin's clinical relevance was recognized as the causative etiology of Botulism in 1897. It was first used to treat a medical condition in the 1980s as an alternative to strabismus surgery. Since its discovery, BoNT has been utilized in multiple medical fields, including but not limited to ophthalmology, dermatology, neurology, and urology. There is enthusiasm within the sexual medicine community about the utility of BoNT in treating male sexual dysfunction. Yet, despite its long track record of safety and efficacy in other areas, its use for treating sexual dysfunction has not been fully explored. Onabotulinumtoxin A (Botox; Allergan Pharmaceuticals, Parsippany, NJ) is the most extensively studied BoNT-A formulation and is FDA approved within the United States to treat multiple pathologies. The mechanism of action, safety profile, and temporal effect of BoNT-A have led to its appeal for use in treating lower urinary tract disorders. In 2011, BoNT-A was approved for treating detrusor overactivity (DO) in patients with neurologic conditions like spinal cord injury and multiple sclerosis. In 2013, the FDA expanded the indication for the use of BoNT-A to patients with non-neurogenic overactive bladder (OAB) syndrome.3 The use of BoNT-A for other urologic conditions is considered “off-label.” Despite its favorable safety profile, providers using BoNT-A should be aware of its local (mild) side effects such as urinary tract infection and urinary retention, as well as potential, systemic (significant) side effects like muscle weakness and respiratory difficulties.
Engy Habashy、Tobias S. K?hler
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Department of Urology, Mayo Clinic, Rochester, MN, USA
NSTL
