Mechanism of action of onabotulinumtoxinA on lower urinary tract dysfunction

Botulinum neurotoxins (BoNTs) are known for their ability to induce chemical denervation, modulation of neurotransmission, and successful long-term treatment of muscle hypercontractility. Recent basic science studies as well as clinical studies suggest that BoNT affects the modulation of sensory processing, inflammation, and glandular function. Causes of lower urinary tract symptoms (LUTS) include abnormalities of the bladder, prostate, urethra, and neurological function that controls the lower urinary tract. Urologists have become interested in the potential application of BoNTs in patients with LUTS including detrusor and sphincter overactivity, bladder hypersensitivity, interstitial cystitis/painful bladder symptoms, and benign prostatic hyperplasia. In this study we review the biological action of BoNTs in the bladder and prostate.