Urological Applications of Botulinum Toxin A

Botulinum toxin A (BoNT-A) has seen in the last two decades an increased level of application in urological practice, first FDA approved in 2011 for neurogenic detrusor overactivity and then later in 2013 for refractory overactive bladder. Hundreds of studies have been published in literature assessing the chemical structure of botulinum toxins and how urothelial injections in the lower urinary tract and vesical instillations can be employed in the management of a spectrum of urological conditions particularly voiding dysfunction. The consensus is still out on toxin A preparations, mode and pattern of application whether instilled or injected intradetrusally, units used, as well as time to onset and duration of effect of injections and is still a dense research topic. This is reflected in the continuously changing and differing grades of recommendations between societies of urological practitioners such as the EAU and AUA, among others. This chapter discusses both the FDA-approved and experimental applications of botulinum toxin A in urology, indications, techniques, and points of debate

[30] Outcomes of emergency vs elective ureteroscopy for a single ureteric stone

Objective: To compare the results of emergency vs elective ureteroscopy (URS) for the treatment of a single ureteric stone. Methods: We prospectively constructed a database for patients who underwent URS in the Al-Amiri Hospital from March 2015 through December 2017. Inclusion criteria were adult patients with a single ureteric stone diagnosed by computed tomography of the kidneys, ureters and bladder. Patients who had fever or ureteric stents were excluded. The emergency URS group (EM Group) included patients who presented to the emergency department with persistent renal colic and underwent emergency URS. The elective URS group (EL Group) included patients who underwent elective URS after admission through the outpatient appointment system. The technique for URS was the same in both groups. Safety was defined as absence of complications, whilst effectiveness was defined as stone-free rate after a single URS session. The chi-squared and t-test were used to compare the data of both groups. Results: The study included 124 patients with a mean (SD) age of 41.4 (12.6) years. The EM Group included 67 patients and the EL Group included 57 patients. Laser disintegration was needed in 48 patients (84%) in the EL Group and 43 (64%) in the EM Group (P = 0.012). Post-URS stents were placed in 43 patients (75.4%) in the EL Group and 60 (89.6) in the EM Group (P = 0.037). Complications were comparable (3.5% for the EL and 4.5% for EM groups, P = 0.785). Ureteric perforation in one patient in the EM Group was treated with a JJ stent. Sepsis in one patient in each group was treated with culture-sensitive antibiotics. Upper tract obstruction after removal of the ureteric catheter in one patient in the EL Group required a JJ stent. Haematuria in one patient in EM Group was treated with blood transfusion. Stone-free rates were comparable, 93% in the EL Group and 97% in the EM Group (P = 0.297). Conclusion: Emergency URS in selected cases can be as safe and effective as elective URS for treatment of a single ureteric stone