POL Scientific / Bladder / Volume 9 / Issue 1 / DOI: 10.14440/bladder.2022.847
Cite this article
1
Download
39
Citations
97
Views
Journal Browser
Volume | Year
Issue
Search
News and Announcements
View All
REVIEW

Chinese botulinum toxin A for the treatment of lower urinary tract dysfunction: It works just as well

Fan Zhang1,‡ Qinggang Liu2,3,‡ Limin Liao1,2,3* Xiaojuan Li4 Xueping Zhang4
Show Less
1 Department of Urology Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, China
2 Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
3 University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China
4 Lanzhou Institute of Biological Products, Lanzhou, Gansu 730046, China
Bladder 2022 , 9(1), 1–9;
Submitted: 28 October 2021 | Revised: 7 March 2022 | Accepted: 22 March 2022 | Published: 14 September 2022
© 2022 by the Author(s). Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

The botulinum neurotoxin type A (BoNT/A) is a neurotoxin produced by Clostridium botulinum. It causes botulism and represents the most powerful natural poison. In urological practice, the indications for BoNT/A therapy include neurogenic detrusor overactivity (NDO), idiopathic overactive bladder (OAB) or idiopathic detrusor overactivity (IDO), detrusor-sphincter dyssynergia (DSD), interstitial cystitis/bladder pain syndrome (IC/BPS), urinary tract infections (UTI), benign prostatic hyperplasia (BPH), and, more recently, chronic prostatic pain (CPP). BoNT/A is not only conducive to the treatment of muscle spasticity but also effectively works on hyperalgesia associated with various disorders of the lower urinary tract, thanks to its anti-nociceptive properties. While Botox® (Allergan Inc., Irvine, CA) is currently being used across the globe, we have been using Chinese BoNT/A for many years for the treatment of DSD, NDO, idiopathic OAB, IC/BPS, BPH and UTI. Our experience showed that Chinese BoNT/A was as good as other BoNT/A products in terms of efficacy, safety, and tolerability. In this study, we explored the current and potential applications of Chinese BoNT/A in urology, and reviewed the background information regarding the toxin.

Keywords
Botulinum neurotoxin type A
Hengli®
Lower urinary tract dysfunction
Detrusor overactivity
Bladder hy-peralgesia
References

1. Munchau A, Bhatia KP. Uses of botulinum toxin injection in medicine today. BMJ. 2000 Jan 15;320(7228):161-5. https://doi.org/10.1136/bmj.320.7228.161 PMID: 10634738

2. Dover N, Barash JR, Hill KK, Xie G, Arnon SS. Molecular characterization of a novel botulinum neurotoxin type H gene. J Infect Dis. 2014 Jan 15;209(2):192-202. https://doi.org/10.1093/infdis/jit450 PMID: 24106295

3. Hill KK, Smith TJ. Genetic diversity within Clostridium botulinum serotypes, botulinum neurotoxin gene clusters and toxin subtypes. Curr Top Microbiol Immunol. 2013;364:1-20. https://doi.org/10.1007/978-3-642-33570-9_1 PMID: 23239346

4. Nitti VW. Botulinum toxin for the treatment of idiopathic and neurogenic overactive bladder: state of the art. Rev Urol. 2006 Fall;8(4):198-208. PMID: 17192799

5. Yao G, Lee K, Gu S, Lam KH, Jin R. Botulinum neurotoxin A complex recognizes host carbohydrates through its hemagglutinin component. Toxins (Basel). 2014 Feb 12;6(2):624-35. https://doi.org/10.3390/toxins6020624 PMID: 24525478

6. Dykstra DD, Sidi AA. Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: a double-blind study. Arch Phys Med Rehabil. 1990 Jan;71(1):24-6. PMID: 2297305

7. Stohrer M, Schurch B, Kramer G. Botulinum A-toxin in the treatment of detrusor hyperreflexia in spinal cord injured patients: a new alternative to medical and surgical procedures? J Urol. 2000 Sep;164(3 Pt 1):692-7. https://doi.org/10.1097/00005392-200009010-00018 PMID: 10953127

8. Karsenty G, Denys P, Amarenco G, De Seze M, Gamé X, Haab F, et al. Botulinum toxin A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. Eur Urol. 2008 Feb;53(2):275-87. https://doi.org/10.1016/j.eururo.2007.10.013 PMID: 17988791

9. Leippold T, Reitz A, Schurch B. Botulinum toxin as a new therapy option for voiding disorders: current state of the art. Eur Urol. 2003 Aug;44(2):165-74. https://doi.org/10.1016/s0302-2838(03)00250-1 PMID: 12875934

10. Zhao Y, Wei R, Liu CM, Zhang XP, Feng DJ, Gao XJ, et al. [Cloning and Sequencing of Complete BoNT Gene of Clostridium botulinum Type A for Therapy]. Chin J Biologicals. 2010;23(06):598-601. Chinese. https://doi.org/10.13200/j.cjb.2010.06.43.zhaoyj.010.

11. Quagliato EM, Carelli EF, Viana MA. Prospective, randomized, double-blind study, comparing botulinum toxins type a botox and prosigne for blepharospasm and hemifacial spasm treatment. Clin Neuropharmacol. 2010 Jan-Feb;33(1):27-31. https://doi.org/10.1097/WNF.0b013e3181c46f61 PMID: 20124784

12. Rieder CR, Schestatsky P, Socal MP, Monte TL, Fricke D, Costa J, et al. A double-blind, randomized, crossover study of prosigne versus botox in patients with blepharospasm and hemifacial spasm. Clin Neuropharmacol. 2007 Jan-Feb;30(1):39-42. https://doi.org/10.1097/01.Wnf.0000236771.77021.3c PMID: 17272968

13. He X, Miao CH, Li XJ, Wang YT, Liang Q, Zhang XP, et al. [Biological characteristics and quality of botulinum toxin type A for injection]. Chin J Biologicals. 2012;25(11):1488-91, 97. Chinese. https://doi.org/10.13200/j.cjb.2012.11.89.hex.039.

14. Inoue K, Fujinaga Y, Watanabe T, Ohyama T, Takeshi K, Moriishi K, et al. Molecular composition of Clostridium botulinum type A progenitor toxins. Infect Immun. 1996;64(5):1589-94. https://doi.org/10.1128/iai.64.5.1589-1594.1996 PMID: 8613365

15. Liang Q, Chen S, Zhang R, Wei Z, Su J, Zhou Y, et al. [Nonclinical safety evaluation of botulinum toxin type A and botulinum neurotoxin type A]. Chin J Biologicals. 2017;30(07):710-7. Chinese. https://doi.org/10.13200/j.cnki.cjb.001797.

16. Chapple C, Patel A. Botulinum toxin--new mechanisms, new therapeutic directions? Eur Urol. 2006;49(4):606-8. https://doi.org/10.1016/j.eururo.2006.01.005 PMID: 1645794517. Kuo HC. Therapeutic effects of suburothelial injection of botulinum a toxin for neurogenic detrusor overactivity due to chronic cerebrovascular accident and spinal cord lesions. Urology. 2006;67(2):232-6. https://doi.org/ 10.1016/j.urology.2005.08.016 PMID: 16442605

18. Schulte-Baukloh H, Schobert J, Stolze T, Stürzebecher B, Weiss C, Knispel HH. Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. Neurourol Urodyn. 2006;25(2):110-5. https://doi.org/10.1002/nau.20153 PMID: 16470519

19. Smith CP, Nishiguchi J, O'Leary M, Yoshimura N, Chancellor MB. Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology. 2005;65(1):37-41. https://doi.org/10.1016/j.urology.2004.08.016 PMID: 15667859

20. Jiang YH, Liao CH, Kuo HC. Current and potential urological applications of botulinum toxin A. Nat Rev Urol. 2015;12(9):519-33. https://doi.org/10.1038/nrurol.2015.193 PMID: 26260879

21. Liao L, Fu G, Shi WB, Xiong ZS, Ju YH, Wu J, et al. [Botulinum-A toxin injection in urinary sphincter by endoscope to treat detrusor-sphincter dyssynergia in patients with spinal cord injury]. Chin J Spine and Spinal Cord. 2006;(06):409-12. Chinese. https://doi.org/10.3969/j.issn.1004-406X.2006.06.002

22. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49. https://doi.org/10.1016/s0090-4295(02)02243-4 PMID: 12559262

23. Sahai A, Khan M, Fowler CJ, Dasgupta P. Botulinum toxin for the 
treatment of lower urinary tract symptoms: a review. Neurourol Urodyn. 2005;24(1):2-12. https://doi.org/10.1002/nau.20090 PMID:15578628

24. Schurch B, Schmid DM, Stöhrer M. Treatment of neurogenic incontinence with botulinum toxin A. N Engl J Med. 2000;342(9):665. https://doi.org/ 10.1056/nejm200003023420918 PMID: 10702067

25. Schurch B, Stöhrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol. 2000 Sep;164(3 Pt 1):692-7. https://doi.org/10.1097/00005392-200009010-00018 PMID: 1095312726. Dickson EC, Shevky R. Botulism. Studies on the manner in which the toxin of clostridium botulinum acts upon the body: I. The effect upon the autonomic nervous system. J Exp Med. 1923 Apr 30;37(5):711-31. https://doi.org/10.1084/jem.37.5.711 PMID:1986875

27. Chen G, Liao L. Injections of Botulinum Toxin A into the detrusor to treat neurogenic detrusor overactivity secondary to spinal cord injury. Int Urol Nephrol. 2011 Sep;43(3):655-62. https://doi.org/10.1007/s11255-010-9873-x PMID: 2111009428. Li D, Liao L, Xiong ZS, Fu G, Ju YH, Wu J, et al. [Botulinum toxin type A repeated injections into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in spinal cord injury patients: 6 cases report]. Chin J Rehabil Theory Practice. 2005;(11):30-1. Chinese. https://doi.org/ 10.3969/j.issn.1006-9771.2005.11.01229.

29. Liao L, Li D, Xiong ZS, Han CS, Huang Y, Shi WB. [Botulinum-A toxin injection into detrusor to treat detrusor hyperreflexia and neurogenic incontinence in patients with spinal cord injury]. Chin J Urol. 2004;(09):19-21. Chinese. https://doi.org/10.3760/j:issn:1000-6702.2004.09.006

30. Liao L, Ju Y, Li D. [Botulinum Toxin-A Injection into Detrusor to Treat Neurogenic Detrusor Overactivity in Patient s with Spinal Cord Injury]. Chin J Rehabil Theory Practice. 2007;(11):1014-6. Chinese. https://doi.org/10.3969/j.issn.1006-9771.2007.11.005

31. Popat R, Apostolidis A, Kalsi V, Gonzales G, Fowler CJ, Dasgupta P. A comparison between the response of patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity to the first intradetrusor injection of botulinum-A toxin. J Urol. 2005 Sep;174(3):984-9. https://doi.org/10.1097/01.ju.0000169480.43557.31 PMID: 16094019

32. Rapp DE, Lucioni A, Katz EE, O'Connor RC, Gerber GS, Bales GT. Use of botulinum-A toxin for the treatment of refractory overactive bladder symptoms: an initial experience. Urology. 2004 Jun;63(6):1071-5. https://doi.org/10.1016/j.urology.2004.01.041 PMID: 15183952

33. Kalsi V, Apostolidis A, Popat R, Gonzales G, Fowler CJ, Dasgupta P. Quality of life changes in patients with neurogenic versus idiopathic detrusor overactivity after intradetrusor injections of botulinum neurotoxin type A and correlations with lower urinary tract symptoms and urodynamic changes. Eur Urol. 2006 Mar;49(3):528-35. https://doi.org/10.1016/j.eururo.2005.12.012 PMID: 16426735

34. Chapple C, Sievert KD, MacDiarmid S, Khullar V, Radziszewski P, Nardo C, et al. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur Urol. 2013 Aug;64(2):249-56. https://doi.org/10.1016/j.eururo.2013.04.001 PMID: 23608668

35. Liao LM, Liu QG, Cong HL, Xu ZH, Li EH, Weng ZL, et al. Hengli® Chinese Botulinum Toxin Type A for Treatment of Patients With Overactive Bladder: A Multicenter, Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol. 2022 Feb 18;13:840695. https://doi.org/10.3389/fphar.2022.840695 PMID: 35250586

36. Liu HT, Kuo HC. Intravesical botulinum toxin A injections plus hydrodistension can reduce nerve growth factor production and control bladder pain in interstitial cystitis. Urology. 2007 Sep;70(3):463-8. https://doi.org/ 10.1016/j.urology.2007.04.038 PMID: 17905097

37. Shie JH, Liu HT, Wang YS, Kuo HC. Immunohistochemical evidence suggests repeated intravesical application of botulinum toxin A injections may improve treatment efficacy of interstitial cystitis/bladder pain syndrome. BJU Int. 2013 Apr;111(4):638-46. https://doi.org/10.1111/j.1464-410X.2012.11466.x PMID:22943596

38. Giannantoni A, Porena M, Costantini E, Zucchi A, Mearini L, Mearini E. Botulinum A toxin intravesical injection in patients with painful bladder syndrome: 1-year followup. J Urol. 2008 Mar;179(3):1031-4. https://doi.org/10.1016/j.juro.2007.10.032 PMID: 18206941

39. Kuo HC. Repeated intravesical onabotulinumtoxinA injections are effective in treatment of refractory interstitial cystitis/bladder pain syndrome. Int J Clin Pract. 2013 May;67(5):427-34. https://doi.org/10.1111/ijcp.12113 PMID: 23574103

40. Kuo HC. Repeated onabotulinumtoxin-a injections provide better results than single injection in treatment of painful bladder syndrome. Pain Physician. 2013 Jan;16(1):E15-23. https://doi.org/10.36076/ppj.2013/16/e15 PMID: 23340540

41. Gao Y, Liao L. Intravesical injection of botulinum toxin A for treatment of interstitial cystitis/bladder pain syndrome: 10 years of experience at a single center in China. Int Urogynecol J. 2015 Jul;26(7):1021-6. https://doi.org/10.1007/s00192-015-2631-y PMID: 25690160

42. Zermann D, Ishigooka M, Schubert J, Schmidt RA. Perisphincteric injection of botulinum toxin type A. A treatment option for patients with chronic prostatic pain? Eur Urol. 2000 Oct;38(4):393-9. https://doi.org/10.1159/000020314 PMID: 11025376

43. Jhang JF, Kuo HC. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection. Toxins (Basel). 2015 Jun 18;7(6):2232-50. https://doi.org/10.3390/toxins7062232 PMID: 26094697

44. Maria G, Brisinda G, Civello IM, Bentivoglio AR, Sganga G, Albanese A. Relief by botulinum toxin of voiding dysfunction due to benign prostatic hyperplasia: results of a randomized, placebo-controlled study. Urology. 2003 Aug;62(2):259-64; discussion 264-5. https://doi.org/10.1016/s0090-4295(03)00477-1 PMID:12893330

45. Chuang YC, Chiang PH, Yoshimura N, De Miguel F, Chancellor MB. Sustained beneficial effects of intraprostatic botulinum toxin type A on lower urinary tract symptoms and quality of life in men with benign prostatic hyperplasia. BJU Int. 2006 Nov;98(5):1033-7; discussion 337. https://doi.org/10.1111/j.1464-410X.2006.06479.x PMID: 16956361

46. Kuo HC, Liu HT. Therapeutic effects of add-on botulinum toxin A on patients with large benign prostatic hyperplasia and unsatisfactory response to combined medical therapy. Scand J Urol Nephrol.2009;43(3):206-11. https://doi.org/10.1080/00365590902811537 PMID: 19308807

47. De Kort LM, Kok ET, Jonges TN, Rosier PF, Bosch JL. Urodynamic effects of transrectal intraprostatic Ona botulinum toxin A injections for symptomatic benign prostatic hyperplasia. Urology. 2012 Oct;80(4):889-93. https://doi.org/10.1016/j.urology.2012.06.004 PMID: 22854138

48. Marberger M, Chartier-Kastler E, Egerdie B, Lee KS, Grosse J, Bugarin D, et al. A randomized double-blind placebo-controlled phase 2 dose-ranging study of onabotulinumtoxinA in men with benign prostatic hyperplasia. Eur Urol. 2013 Mar;63(3):496-503. https://doi.org/10.1016/j.eururo.2012.10.005 PMID: 2309876249. Soden RJ, Walsh J, Middleton JW, Craven ML, Rutkowski SB, Yeo JD. Causes of death after spinal cord injury. Spinal Cord. 2000 Oct;38(10):604-10. https://doi.org/10.1038/sj.sc.3101080 PMID: 11093321

50. Whiteneck GG, Charlifue SW, Frankel HL, Fraser MH, Gardner BP, Gerhart KA, et al. Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia. 1992 Sep;30(9):617-30. https://doi.org/10.1038/sc.1992.124 PMID:1408338

51. Esclarín De Ruz A, García Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol. 2000 Oct;164(4):1285-9. PMID: 10992382.

52. Gamé X, Castel-Lacanal E, Bentaleb Y, Thiry-Escudié I, De Boissezon X, Malavaud B, et al. Botulinum toxin A detrusor injections in patients with neurogenic detrusor overactivity significantly decrease the incidence of symptomatic urinary tract infections. Eur Urol. 2008 Mar;53(3):613-8. https://doi.org/10.1016/j.eururo.2007.08.039 PMID: 17804150

53. Jia C, Liao LM, Chen G, Sui Y. Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury. Spinal Cord. 2013 Jun;51(6):487-90. https://doi.org/10.1038/sc.2012.180 PMID: 23357928

Share
Back to top
Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific