Graphique 1 - Faculté de Médecine et de Pharmacie de Fès

Summary
For over a quarter century, local injections of botulinum toxin have provided
clinical benefit for conditions with unmet need, characterized by inappropriately
contracting muscles with or without pain or sensory disturbance.
Botulinum toxin is a neurotoxin produced by the anaerobic bacterium
Clostridium botulinum. Of the seven serotypes (A through G), A, B, and E have been
implicated in the occurrence of botulism. Only A and B are used for therapeutic
purposes.
Botulinum toxins bind irreversibly to the presynaptic receptors at the
neuromuscular junction, thereby inhibiting acetylcholine release. Although this
permanently inactivates the neuromuscular junction, collaterals grow and form new
junctions within a few weeks or months, so that the effect of the injections is
temporary.
Botulinum toxin has been used in urology and neurourology since the end of
the 80 s. Its ease of use and some promising results incite to try it in numerous
indications.
The best indications of botulinum toxin in urology are neurogenic detrusor
hyperactivity and vesico-sphincter dyssynergia. Currently, indications are beginning
to expand to treat interstitial cystitis, benign prostatic hyperplasia and the pain of
chronic prostatitis.
Detrusor injections of botulinum toxin type A constitute an alternative
conservative treatment that is effective in a short term (6-12 months) after failure of
anticholinergic agents to treat neurogenic detrusor hyperactivity. The results have
shown a remarkable improvement of clinical and urodynamic parameters (increase in
the maximum bladder capacity, the volume reflex onset of first contraction, post
voiding residue and decrease in the maximum pressure detrusor per voiding). The
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