Open Journal of Urology, 2012, 2, 67-71 doi:10.4236/oju.2012.22011 Published Online May 2012 (http://www.SciRP.org/journal/oju) 67 Botulinum Toxin-A for the Treatment of Voiding Dysfunction: Our Initial Experience Sinharib Citgez, Bulent Onal, Fetullah Gevher, Cagatay Dogan, Omer Kurt, Oktay Demirkesen, Bulent Cetinel * Department of Urology, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey Email: * bulent.cetinel@hotmail.com Received March 14, 2012; revised March 26, 2012; accepted April 10, 2012 ABSTRACT Objective: Evaluation of Botulinum Toxin-A (BTX-A) as an alternative treatment option in patients whom previous treatments were failed. Methods: Between March 2005 and September 2006, a total 19 patients; 16 patients with overactive bladder (5 neurologic, 11 idiopathic), 2 with nocturnal enuresis, 1 with interstitial cystitis, intravesical BTX-A injection was applied. Except one patient, 18 patients with a median age 46 (20 - 80) were registered to the stu- dy. Patients were examined at postoperative 3 weeks and 6 months with ICIQ-SF (International Consultation on Incon- tinence Questionnaire-Short Form) and satisfaction forms used in our clinic. Results: The median follow-up time was 16 months (6 - 18). When evaluated according to diagnosis, symptoms were improved 100% in neurologic overactive bladder (5/5), 80% in idiopathic overactivity (8/10), 50% in nocturnal enuresis (1/2). In one patient with interstitial cystitis there was no improvement. Median efficiency time of BTX-A treatment was 6 months (1 - 17). At 3 weeks and 6 months after the treatment, ICIQ-SF score was decreased to 3.6 and 7.5 respectively from preoperative level of 18.7. Quality of life scores at preoperative, 3 week and 6 months were 9.7, 2.7 and 4.3 respectively. Except 3 patients with overactive neurologic bladder because of spinal cord injury, symptoms of patients with pollacuria and nocturia decreased at 3. week. Even if these rates increased at 6 months they still were significantly less than preoperative status. The spinal cord injured 3 patients had clean intermittent catheterization per 1 hour and had urinary incontinence between the catheterizations preoperatively, however at 3 weeks and 6 months the intervals of catheterisations was 4 hours and 3 hours respectively and also the urinary incontinance between the catheterisations improved. At patient satisfactions, 78% of patients declared that they were pleased and underwent the procedure again and will recommend it to their relatives with similar problems. One patient had a complication as tansient weakness on her legs. Conclusion: BTX-A injections provide an alternative treatment before surgery at overactive bladder especially for those who doesn’t response to medical treatment or cannot use antimuscarinics because of their side effects. Further studies with a greater number of patients are needed for determining the effectiveness of BTX-A on patients with voiding dysfunctions. Keywords: Botulinum Toksin-A; Overactive Bladder; Voiding Dysfunction 1. Introduction Botulinum toxin (BTX) was described first by Van Er- mengem in 1897 [1]. Botulinum is known as the most potent biological toxin and has been increasingly used as an effective treatment method in numerous diseases. Botulinum toxin has 7 different serotypes called A, B, C, D, E, F and G [2]. However, only A and B types are used for treatment purposes. Demonstrating of BTX to produce neuromuscular blockade has been a rationale for its clinical practicability [3]. However, first usage of this toxin in the treatment was for resolving of strabismus in human, and the results were published in 1980 [4]. Botulinum toxin shows its muscle relaxant effect by transiently inhibiting the release of acetylcholine in presynaptic cholinergic junction. The clinical effect of Botulinum toxin is transient and depends on the dose. BTX has been given efficient and reliable results so far with reversible effects, which increase the medical area of use for this toxin. It is used for muscle spasm and re- sultant many head and neck diseases with a painful course. These diseases include blepharospasm, facial dys- kinesias, spastic dysphonia, oromandibular dystonia and spasmodic torticollis. In addition, BTX is also used for hyperhidrosis, achalasia, focal spasticity and resolving of wrinkles. In urological area, BTX has been used in detrusor sphincter dyssynergia (DSD) [5], urinary dysfunction [6], neurogenic detrusor overactivity (NDO) [7] or idiopathic/ non-neurogenic detrusor overactivity (NNDO) [8], chronic prostatitis [9], chronic pelvic pain syndrome [10] and * Corresponding author. Copyright © 2012 SciRes. OJU