Research points to expanding role of botulinum toxin in several urologic indications

In this interview, Michael B. Chancellor, MD, discusses using botulinum toxin for treating overactive bladder, BPH, interstitial cystitis, and other conditions.

The process by which this biological neuromodulator works is incredibly elegant. It has one of the highest affinities of any chemical or biologic ever discovered, meaning that even the smallest amount presented to a nerve terminal will irreversibly bind to the presynaptic neuronal membrane, enter the cell, and block specific Soluble NSF Attachment Protein Receptor (SNARE) proteins that would normally allow the release of the neurotransmitter that's essential for all muscle and sensory neuropeptide release.

Q: Let's talk about the use of botulinum toxin in overactive bladder. Is it important to distinguish between neurogenic and idiopathic overactivity for the purposes of this discussion?

Q: How does botulinum toxin work in OAB? Do we know whether nerve growth factor produced in the urothelium is actually excreted in the urine?

NGF implies neuroinflammation and abnormal nerve function. If the NGF level changes, you know the treatment is having a significant effect. The correlation between responders and non-responders is very exciting.