Use of Botulinum Toxin in the Genitourinary System.

Botulinum toxin injection has been widely accepted by the urology and urogynecology medical communities as a safe and effective treatment for refractory urinary incontinence. There are two approved genitourinary indications for botulinum toxin. OnabotulinumtoxinA (onaBoNTA) 200 U for the treatment of urinary incontinence due to detrusor overactivity associated with a neurologic condition (e.g., spinal cord injury, multiple sclerosis) in adults who have an inadequate response to or are intolerant of an anticholinergic medication. In addition, onaBoNTA 100 U is used for the treatment of overactive bladder with symptoms of urinary incontinence, urgency, and frequency, in adult patients who have an inadequate response to or are intolerant of an anticholinergic medication. We will discuss the application of botulinum toxin for genitourinary indications with a focus on bladder injection and on potential use of BoNT use in the prostate and pelvic floor.