*Review* **Mechanism of Action of Botulinum Toxin A in Treatment of Functional Urological Disorders**

**Yu-Hua Lin 1,2,3, Bing-Juin Chiang 1,4,5 and Chun-Hou Liao 1,4,\***


Received: 31 December 2019; Accepted: 14 February 2020; Published: 18 February 2020

**Abstract:** Intravesical botulinum toxin (BoNT) injection is effective in reducing urgency and urinary incontinence. It temporarily inhibits the detrusor muscle contraction by blocking the release of acetylcholine (Ach) from the preganglionic and postganglionic nerves in the efferent nerves. BoNT-A also blocks ATP release from purinergic efferent nerves in the detrusor muscle. In afferent nerves, BoNT-A injection markedly reduces the urothelial ATP release and increases nitric oxide (NO) release from the urothelium. BoNT-A injection in the urethra or bladder has been developed in the past few decades as the treatment method for detrusor sphincter dyssyndergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders, including bladder hypersensitivity, overactive bladder, and interstitial cystitis/chronic pelvic pain syndrome. Although the FDA only approved BoNT-A injection treatment for neurogenic detrusor overactivity and for refractory overactive bladder, emerging clinical trials have demonstrated the benefits of BoNT-A treatment in functional urological disorders. Cautious selection of patients and urodynamic evaluation for confirmation of diagnosis are crucial to maximize the successful outcomes of BoNT-A treatment.

**Keywords:** botulinum toxin; functional urology disorder; human

**Key Contribution:** This article reviewed the mechanism of action of botulinum toxin A in treatment of different urological disorders.
