Micturition, or urination, occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. The neural circuitry that controls this process is complex and highly distributed: it involves pathways at many levels of the brain, the spinal cord and the peripheral nervous system and is mediated by multiple neurotransmitters. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary or reflex micturition, leading to urinary incontinence. This is a major health problem, especially in those with neurological impairment. Here we review the neural control of micturition and how disruption of this control leads to abnormal storage and release of urine.

/pdf/the-neural-control-of-micturition-1ofs2ivm8i.pdf

The neural control of micturition

https://uroweb.org/wp-content/uploads/20_Neurogenic-LUTD_LR.pdf

EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction

Objective: To perform an evidence-based review of the safety and efficacy of botulinum neurotoxin (BoNT) in the treatment of autonomic and urologic disorders and low back and head pain. Methods: A literature search was performed including MEDLINE and Current Contents for therapeutic articles relevant to BoNT and the selected indications. Authors reviewed, abstracted, and classified articles based on the quality of the study (Class I–IV). Conclusions and recommendations were developed based on the highest level of evidence and put into current clinical context. Results: The highest quality literature available for the respective indications was as follows: axillary hyperhidrosis (two Class I studies); palmar hyperhidrosis (two Class II studies); drooling (four Class II studies); gustatory sweating (five Class III studies); neurogenic detrusor overactivity (two Class I studies); sphincter detrusor dyssynergia in spinal cord injury (two Class II studies); chronic low back pain (one Class II study); episodic migraine (two Class I and two Class II studies); chronic daily headache (four Class II studies); and chronic tension-type headache (two Class I studies). Recommendations: Botulinum neurotoxin (BoNT) should be offered as a treatment option for the treatment of axillary hyperhidrosis and detrusor overactivity (Level A), should be considered for palmar hyperhidrosis, drooling, and detrusor sphincter dyssynergia after spinal cord injury (Level B), and may be considered for gustatory sweating and low back pain (Level C). BoNT is probably ineffective in episodic migraine and chronic tension-type headache (Level B). There is presently no consistent or strong evidence to permit drawing conclusions on the efficacy of BoNT in chronic daily headache (mainly transformed migraine) (Level U). While clinicians’ practice may suggest stronger recommendations in some of these indications, evidence-based conclusions are limited by the availability of data. Neurology ® 2008;70:1707–1714

https://n.neurology.org/content/neurology/70/19/1707.full.pdf

Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology

https://www.europeanurology.com/article/S0302-2838(11)00739-1/pdf/efficacy-and-safety-of-onabotulinumtoxina-in-patients-with-urinary-incontinence-due-to-neurogenic-detrusor-overactivity-a-randomised-double-blind-placebo-controlled-trial

Efficacy and Safety of OnabotulinumtoxinA in Patients with Urinary Incontinence Due to Neurogenic Detrusor Overactivity: A Randomised, Double-Blind, Placebo-Controlled Trial

https://www.europeanurology.com/article/S0302-2838(07)01264-X/pdf

Botulinum Toxin A (Botox®) Intradetrusor Injections in Adults with Neurogenic Detrusor Overactivity/Neurogenic Overactive Bladder: A Systematic Literature Review

BackgroundPublished evidence suggests that botulinum toxin type A (BTX-A) is an effective treatment for crow's feet. However, few dose-ranging studies have been performed.ObjectivesTo assess the safety and efficacy of a single treatment with one of four doses of BTX-A (Botox/Vistabel, Allergan Inc)

Double‐Blind, Randomized, Placebo‐Controlled, Dose‐Response Study of the Safety and Efficacy of Botulinum Toxin Type A in Subjects with Crow's Feet

Botulinum toxin A (BOTOX (R)) in neurogenic urinary incontinence: results from a multi-centre randomised, controlled trial.

Botulinum toxin type A is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study.

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Papers

Double‐Blind, Randomized, Placebo‐Controlled, Dose‐Response Study of the Safety and Efficacy of Botulinum Toxin Type A in Subjects with Crow's Feet

Botulinum toxin A (BOTOX (R)) in neurogenic urinary incontinence: results from a multi-centre randomised, controlled trial.

Botulinum toxin type A is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study.