The Unusual History and the Urological Applications of Botulinum Neurotoxin

Introduction: Botulinum neurotoxin (BoNT) is probably the most potent biological toxin that can affect humans. Since its discovery by Justinus Kerner, BoNT has seen use in a wide range of cosmetic and non-cosmetic conditions such as cervical dystonia, cerebral palsy, migraines and hyperhidrosis. We tried to trace its history from its inception to its recent urological applications. Materials and Methods: Historical articles about botulinum toxin were reviewed and a Medline search was performed for its urological utility. We hereby present a brief review of historical aspects of BoNT and its applications in urology. Results: In 1793, the first known outbreak of botulism occurred due to ‘spoiled’ sausage in Wildebad, Germany. The German physician and poet Justinus Kerner published the first accurate description of the clinical symptoms of botulism (sausage poison). He was also the first to mention its potential therapeutic applications. In urology, BoNT has been used in bladder and urethral lesions with varying degree of success. Recently, BoNT applications were explained for prostatic disorders. BoNT applications in urology are in the treatment of detrusor external sphincter dyssynergia, detrusor overactivity, detrusor underactivity, spastic conditions of the urethral sphincter, chronic prostate pain, interstitial cystitis, non-fibrotic bladder outflow obstruction (including benign prostatic hyperplasia) and acute Published online: July 27, 2010 Mr Vishwanath Hanchanale, MBBS, MS, MRCS Lancashire Teaching Hospitals NHS Trust Fulwood, Preston, PR2 9HT (UK) Tel. +44 1772 522 468, Fax +44 1772 522 946 E-Mail vishwanath.hanchanale @ gmail.com © 2010 S. Karger AG, Basel 0042–1138/10/0852–0125$26.00/0 Accessible online at: www.karger.com/uin Vishwanath S. Hanchanale a Amrith Raj Rao b Francis L. Martin c Shyam S. Matanhelia a a Lancashire Teaching Hospitals NHS Trust, Preston , b Wexham Park Hospital, Slough , and c Centre for Biophotonics, LEC, Lancaster University, Bailrigg,