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BT is associated with fewer side effects than TN but there is no difference in fissure healing or recurrence. Patients need to be warned regarding the risk of transient anal incontinence associated with BT.

Botulinum toxin injection vs topical nitrates for chronic anal fissure: an updated systematic review and meta-analysis of randomized controlled trials. La toxine botulique et la trinitrine ont la même efficacité pour guérir une fissure anale.

Thématique : - Colo-proctologie. Botulinum toxin has a promising future in urology but requires further scientific evaluation.

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Revue systématique de la littérature à partir de la banque de données PubMed. Dix-neuf études ont été retenues dont trois essais randomisés. Les effets secondaires sont rares, dominés par le risque de rétention urinaire qui semble corrélé à la dose utilisée. The condition manifests itself as an overactive bladder syndrome. The sometimes major sociopsychological impact of this condition justifies appropriate therapeutic management.

The prevalence of bladder overactivity varies with age and gender. Its incidence increases with age and is respectively The use of botulinum toxin A in children with a non neurogenic overactive bladder.

Anticholinergic drugs represent the first-line treatment for bladder overactivity. This therapy is usually effective but often produces troublesome side effects which may prompt patients to stop taking their medication. The following keywords were used: botulinum toxin, detrusor overactivity, non-neurogenic, refractory, urodynamic status. Botulinum toxin is a neurotoxin produced by the sporulating, anaerobic, Gram-negative bacterium Clostridium botulinumwhich is widely distributed in the environment soil, dust, etc.

In the s, Dyskra et al.

Botulinum toxin was subsequently used by Schurch in in the treatment of detrusor overactivity in spine-injured patients. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? In striated muscle, botulinum toxin has endopeptidase activity in the cytoplasm of peripheral nerve endings. The internalized neurotoxin is cleaved into two protein chains which deactivate the soluble N-ethylmaleimide-sensitive factor attachment receptor SNARE family proteins required for exocytosis of synaptic vesicles at the nerve ending.

A number of authors have demonstrated that botulinum toxin also inhibits the urothelial and suburothelial release of various mediators acetylcholine, ATP, substance P, glutamate, etc. This suggests an effect on both the efferent part of the voiding reflex and regulation of the afferent message. Modified expression of certain receptors has also been reported by Apostolidis et al. Intradetrusor injections of botulinum toxin are performed on an outpatient basis or during day hospitalization.

The urine must be germ-free. Prophylaxis with antibiotics is not always justified. Injections are made at between 20 and 30 detrusor sites depending on the research protocol in question and outside the trigonal region, in most cases ; this corresponds to four to six sites in the posterior, upper and left and right faces, respectively.

The injections are performed in the upper part of the detrusor muscle. It is not medically justified to leave an indwelling catheter in the bladder. The procedure usually takes around 20 minutes. By analogy with other indications in striated muscle, intramuscular injections were performed initially.

Will suburothelial injection of small dose of botulinum toxin have similar therapeutic effects and less adverse events on refractory detrusor overactivity? Its effect persists for between six and nine months, depending on the study in question. In the absence of specific studies, the reinjection criteria and frequency remain to be established.

On the whole, two strategies can be used: reinjection before the recurrence of symptoms or following the reappearance of urine leakage or urgency.

Table 1 summarizes the various studies on the efficacy of botulinum toxin in the symptomatic treatment of NNDO. In all, 19 studies have been performed.

Only three of these were randomized; the remainder were open-label studies. The primary inclusion criterion in these studies generally corresponded to second-line treatment for refractory or intolerably troublesome bladder overactivity or contraindication of anticholinergic drugs.

The criteria used to evaluate the efficacy of botulinum toxin in this situation vary considerably from one group to another. This latter method of leakage quantification must, however, be used with caution, since it has not been validated for urge incontinence. Urodynamic parameters are also used to evaluate the effect of the toxin on bladder function, both in terms of efficacy and safety of use risk of retention.

Other urodynamic parameters such as the maximum urinary flow rate and bladder contractility are monitored to detect possible complications of treatment with botulinum toxin. InSchmid et al. The dose injected avoiding the trigone was U. The absence of clinical and urodynamic improvement was noted in eight patients who initially had compliance disorders. This study had the advantage of being prospective and investigated a large number of patients.

Sahai is one of the few authors to have performed a randomized, placebo-controlled study.

Usefulness of intra-articular botulinum toxin injections. A systematic review.

Ce traitement s'est imposé ces dernières années pour traiter les dystonies focales. Les résultats sont moins bons dans la crampe des écrivains. Botulinum toxin type A is the most potent of the 7 serotypes produced by the anaerobic bacterium Clostridium botulinum. Minute quantities of botulinum toxin type A offer significant potential in treating a wide variety of disorders associated with muscle overactivity. History of Botulinum Toxin Type A Work with botulinum toxin type A as a therapeutic agent to treat human disease began in the late s through the collaboration of Alan B.

Schantz, PhD, director of food microbiology and toxicology at the University of Wisconsin.