February 2004

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Check out From the Laboratories, an online newsletter that focuses on research.

Botox® provides relief for overactive bladder

By John Tyler

Christopher Smith, MD, assistant professor urology at Baylor College of Medicine, demonstrates where injections of Botox® are placed in the bladder.

One of the most toxic substances known to man could become the most effective means to treat the 33 million Americans suffering with overactive bladders.

Botox®, best known in recent years for smoothing facial wrinkles, is now giving new hope to patients with urinary incontinence or painful urination. Christopher P. Smith, MD, assistant professor of urology at Baylor College of Medicine (BCM), uses Botox® in his clinic. He has conducted important research on its effectiveness in bladder and urethral disorders.

“I was going to the bathroom up to 30 times a day,” said patient Cindy Sinclair. “I think it was most frustrating because I was always on the go, always involved, always doing something. And I got to where I could hardly get outside the house to come to the office.”

Sinclair tried numerous medications, but every therapy failed. Botox® finally gave her the relief she sought.

Using a cystoscope, urologists inject Botox® into numerous sites in the bladder. The toxin works by inactivating proteins involved in neurotransmitter release from nerve terminals. (Neurotransmitters are chemical messengers that carry information from one nerve cell to another.) As neurotransmitter levels decrease, the underlying muscles weaken or become paralyzed.

“It prevents the muscles from having the spasms that cause patients to experience urinary frequency and urgency,” Smith said. “It's very durable in that these patients will have a good response lasting anywhere from four to six months, sometimes even longer.”

BCM has received a grant from Allergan, the makers of Botox®, to study new urologic uses of the toxin. Smith and other researchers in the BCM Scott Department of Urology are also examining whether Botox® may be useful to treat patients with urinary symptoms due to an enlarged prostate (benign prostatic hyperplasia).

Research in the Scott Department of Urology currently focuses on determining the effectiveness of Botox® in the lower urinary tract. Testing is underway to answer several questions:

• Does the toxin have any sensory effects on the nerves that transmit pain?
• What effect does Botox® have on animal models with spinal cord injuries and chronic inflammation?
• How do nerves recover function after Botox® treatment and are there ways to prolong its effects or make it more durable for patients?

“Botox® offers an exciting, new area of research and we expect to be one of the leading centers in taking this new information from the labs straight to the bedside,” Smith said.

(Smith was recently invited to present on this topic for the Interstitial Cystitis Network. For his notes and more information on the use of Botox® for urinary disorders visit http://www.ic-network.com/guestlectures/smith.html)

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