{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:48:56Z","timestamp":1792612136260,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Neurogenic lower urinary tract dysfunction (NLUTD) severely impairs patient quality of life (QoL). While oral medications are often first\u2010line treatments, their high failure rates and side effects limit their effectiveness. Thus, we argue for the use of intravesical botulinum toxin A (BoNT\u2010A) injections as a first\u2010line alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A PubMed search identified 81 studies on NLUTD and BoNT\u2010A, 26 of which were analyzed for the efficacy of BoNT\u2010A as a first\u2010line treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>BoNT\u2010A significantly improved renal function and urinary continence, as indicated by significant reductions in maximum detrusor pressure and increases in maximum cystometric capacity, respectively. Mechanisms for which BoNT\u2010A treatment also improved urinary urgency were found to include sensory pathway modulation and neurotransmitter inhibition. Finally, QoL was found to significantly improve across multiple criteria, including sexual function such as lubrication and orgasm. Importantly, early initiation of BoNT\u2010A treatment yielded better outcomes, emphasizing its value as a first\u2010line treatment. Although side effects include increased post\u2010void residual (PVR), pain, muscle weakness, and reduced efficacy over time, studies have shown that these effects are manageable with dose adjustments and anesthetics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BoNT\u2010A offers substantial therapeutic benefits for NLUTD and demonstrates greater effectiveness when used early; thus, it should be considered a first\u2010line treatment option.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70216","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T07:20:16Z","timestamp":1769757616000},"page":"1479-1481","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cWhat Medical Management Should Be First Line for Bladder Storage Symptoms in NLUTD\u201d\u2014Pro Botox"],"prefix":"10.1002","volume":"45","author":[{"given":"Vada","family":"Furlan","sequence":"first","affiliation":[{"name":"Department of Urology University of California Irvine Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Urology University of California Irvine Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhina","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Department of Urology University of California Irvine Orange California 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