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• W2551911895 abstract "No AccessJournal of UrologyReview Article1 Apr 2017Past, Present and Future of Chemodenervation with Botulinum Toxin in the Treatment of Overactive Bladder Pradeep Tyagi, Mahendra Kashyap, Naoki Yoshimura, Michael Chancellor, and Christopher J. Chermansky Pradeep TyagiPradeep Tyagi Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania More articles by this author , Mahendra KashyapMahendra Kashyap Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania More articles by this author , Naoki YoshimuraNaoki Yoshimura Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania More articles by this author , Michael ChancellorMichael Chancellor Department of Urology, William Beaumont School of Medicine, Royal Oak, Michigan Financial interest and/or other relationship with Lipella Pharmaceuticals. More articles by this author , and Christopher J. ChermanskyChristopher J. Chermansky Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania Financial interest and/or other relationship with Cook Myosite. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.11.092AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We systematically reviewed preclinical and clinical studies on bladder chemodenervation with onabotulinumtoxin A to highlight current limitations and future drug delivery approaches. Materials and Methods: We identified peer reviewed basic and clinical research studies of onabotulinumtoxin A in the treatment of neurogenic bladder and refractory idiopathic overactive bladder published between March 2000 and March 2016. Paired investigators independently screened 125 English language articles to identify controlled studies on onabotulinumtoxin A administration in the MEDLINE® database and abstracts presented at annual American Urological Association meetings. The review yielded an evidence base of more than 50 articles relevant to the approach of injection-free onabotulinumtoxin A chemodenervation. Results: The efficacy and safety of intradetrusor injection of onabotulinumtoxin A for the treatment of overactive bladder are sensitive to injection volume and depth, and this issue has motivated researchers to study injection-free modes of drug delivery into the bladder. Urothelial denudation with protamine sulfate or dimethyl sulfoxide, liposome encapsulated onabotulinumtoxin A and other physical approaches are being studied to increase toxin permeability and avoid intradetrusor injections. Liposome encapsulated onabotulinumtoxin A enhances toxin activity while reducing its toxin degradation. The safety and efficacy of liposome encapsulated onabotulinumtoxin A were tested in a multicenter, placebo controlled study. Although this treatment successfully reduced urinary frequency and urgency, it did not significantly reduce urgency urinary incontinence episodes. Conclusions: Intradetrusor injection of onabotulinumtoxin A is a safe and effective treatment as reported in several large multicenter, randomized controlled trials. Injection of the toxin into the bladder wall impairs afferent and efferent nerves, but injection-free drug delivery approaches only impair the bladder afferent nerves. Further studies are needed to develop better drug delivery platforms that overcome the drawbacks of intradetrusor injection, increase patient acceptance and reduce treatment costs. References 1 : Physiology of micturition. In: Textbook of Female Urology and Urogynecology, 4th ed. Edited by L Cardozo and D Staskin. London: CRC Press2016: 16. 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Link, Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 197Issue 4April 2017Page: 982-990 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsbotulinum toxinshydrogelnerve blockpeptidesliposomesMetricsAuthor Information Pradeep Tyagi Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania More articles by this author Mahendra Kashyap Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania More articles by this author Naoki Yoshimura Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania More articles by this author Michael Chancellor Department of Urology, William Beaumont School of Medicine, Royal Oak, Michigan Financial interest and/or other relationship with Lipella Pharmaceuticals. More articles by this author Christopher J. Chermansky Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania Financial interest and/or other relationship with Cook Myosite. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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