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14 - Bladder and bowel indications

Published online by Cambridge University Press:  02 December 2009

By
Giuseppe Brisinda ,
Federica Cadeddu  and
Giorgio Maria
Edited by
Anthony B. Ward  and
Michael P. Barnes
Giuseppe Brisinda
Affiliation:
Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy
Federica Cadeddu
Affiliation:
Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy
Giorgio Maria
Affiliation:
Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy
Anthony B. Ward
Affiliation:
University Hospital of North Staffordshire
Michael P. Barnes
Affiliation:
Hunters Moor Regional Neurological Rehabilitation Centre
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Summary

Introduction

Botulinum neurotoxin (BoNT) inhibits neuromuscular transmission and it has become a drug with many indications. The range of clinical applications has grown to encompass several neurological and non-neurological conditions. Over the years, the number of primary clinical publications has grown exponentially, and continues to increase every year. Although BoNT blocks cholinergic nerve endings in the autonomic nervous system, it has also been shown that it does not block non-adrenergic non-cholinergic responses mediated by nitric oxide (NO). This has promoted further interest in using BoNT as a treatment for overactive smooth muscles and sphincters (Table 14.1).

Recent clinical experience of BoNT in urological impaired patients will be described in this chapter. Moreover, understanding the anatomical and functional organization of gastrointestinal tract (GIT) innervation is necessary to understand many features of BoNT action on the GIT and the effect of injecting specific sphincters. This chapter presents current data on the use of BoNT to treat GIT diseases and summarizes recent knowledge on the pathogenesis of GIT disorders due to a dysfunction of the enteric nervous system (ENS).

Urinary bladder indications

Anatomy and physiology of micturition

The two functions of lower urinary tract (LUT) are storage and active expulsion of urine. The LUT consists of the bladder (detrusor muscle bundles) and the urethra. The urethra contains a dual sphincter mechanism. The internal sphincter is a smooth muscle part of the vesical neck and posterior urethra with both adrenergic and cholinergic innervation.

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Clinical Uses of Botulinum Toxins , pp. 282 - 327
Publisher: Cambridge University Press
Print publication year: 2007

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  • Bladder and bowel indications
    • By Giuseppe Brisinda, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy, Federica Cadeddu, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy, Giorgio Maria, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy
  • Edited by Anthony B. Ward, Michael P. Barnes
  • Book: Clinical Uses of Botulinum Toxins
  • Online publication: 02 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544842.014
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  • Bladder and bowel indications
    • By Giuseppe Brisinda, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy, Federica Cadeddu, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy, Giorgio Maria, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy
  • Edited by Anthony B. Ward, Michael P. Barnes
  • Book: Clinical Uses of Botulinum Toxins
  • Online publication: 02 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544842.014
Available formats
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  • Bladder and bowel indications
    • By Giuseppe Brisinda, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy, Federica Cadeddu, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy, Giorgio Maria, Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, Rome, Italy
  • Edited by Anthony B. Ward, Michael P. Barnes
  • Book: Clinical Uses of Botulinum Toxins
  • Online publication: 02 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544842.014
Available formats
×