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Neuromodulation Adjuncts

Injectable biologic agents used as neuromodulatory therapy. The category is currently dominated by botulinum toxin applications across bladder (intradetrusor for OAB and NDO), external sphincter (for detrusor-sphincter dyssynergia and primary bladder neck obstruction), pelvic floor (for hypertonicity and CP/CPPS), and a growing list of off-label uses including IC/BPS intratrigonal injection. This subsection covers the pharmacologic agents themselves; for the device-based neuromodulation procedures (sacral neuromodulation, percutaneous tibial nerve stimulation), see the Treatment Atlas neuromodulation procedures.

  • Botulinum ToxinOnabotulinumtoxinA (Botox) — the dual efferent + afferent + anti-inflammatory mechanism. OAB 100 U with the AUA/SUFU 2024 bypass-oral policy and Nitti 2013 / 2016 efficacy data. NDO 200 U (Ginsberg) including Tullman 2018 Class I low-dose 100 U for non-catheterizing MS. ROSETTA 2016 head-to-head vs sacral neuromodulation. Eilber 2025 expert-consensus technique with the 360 U / 3-month ceiling. Off-label DSD, PBNO, IC/BPS intratrigonal, CP/CPPS — and the decisively negative BPH data (Marberger, McVary).