Indications
Botox is a prescription medicine injected into the bladder muscle. Indicated to treat OAB symptoms and refractory urge incontinence in patients when another type of medication does not work well enough or is not tolerated. It is also indicated for leakage due to OAB in patients with neurologic disease who still leak or cannot tolerate the side effects of medication.
How it Works
Small doses of this drug can paralyze muscles. When injected into the bladder muscle, this drug may help keep it from contracting too often. BOTOX works by blocking the nerve signals in your bladder that cause the unstable, overactive bladder contractions. Over time, this treatment wears off and it may need to be repeated in 6 months or a year.
Procedure
BOTOX is injected in multiple areas of your bladder muscle using a cystoscope (Small lighted camera inserted through the urethra) and a special needle which allows us to inject the medication at the exact depth we want. This can be performed in the clinic or in the operating room. The procedure takes approximately 30 minutes and upon discharge, minimal adverse effects are noted.
Depending on whether your procedure is done under local anesthetic or in the operating room with an anesthesiologist will determine whether you can leave immediately and whether you will be able to drive yourself home after the injection of BOTOX.
After the procedure, you will be able to leave in a very short time and should not have any significant discomfort or interference with your normal routine. You should be able to get back to normal activities the following day.
Expected Results
BOTOX can provide up to 6 months of improvement in symptoms in patients who have not been able to tolerate anticholinergic medications or had incomplete success with medications.
Results are not immediate as it may take several weeks to see a change in urinary symptoms.
Symptom improvement (leakage episodes) varies but approximately 2 out of 3 patients experience more than 50% improvement, one out of two patients achieve more than 75% improvement and approximately 30% of patients improve 100%.
The improvement in symptoms includes decreasing daily leakage, improving urgency and decreasing urinary frequency.
Overall quality of life improvement is not just based on decreasing urinary symptoms, but also on improvements in avoidance behaviors (bathroom mapping, fluid restriction), frustration and embarrassment. In most trials, the measured quality of life was significantly improved.
Common Side Effects
- Urinary tract infection (18%)
- Dysuria (9%) is painful or uncomfortable urination
- Urinary retention (6%): Difficulty emptying your bladder is a very frustrating side effect. If you are unable to empty your bladder you may need to perform intermittent catheterization
There are important safety considerations when utilizing BOTOX which are important to understand both for the patient and the provider.
Do not use BOTOX if you have an active urinary tract infection or are not able or willing to initiate catheterization after the injection procedure. Due to the risk of urinary retention only patients who are willing and able to do intermittent catheterization should be considered for treatment.
Do not take BOTOX® if you: are allergic to any of the ingredients in BOTOX® ; had an allergic reaction to any other botulinum toxin product such as Myobloc® Dysport®, or Xeomin®; have an infection at the planned injection site.
Serious side effects can occur and if you experience any of these please get medical attention right away. These problems have been reported to occur at any time (hours to weeks) after injection.
Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months.
Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing.
BOTOX® may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX®. If this happens, do not drive a car, operate machinery, or do other dangerous activities.
Serious and/or immediate allergic reactions have been reported. They include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint.
Get medical help right away if you experience symptoms; further injection of BOTOX® should be discontinued.
Prior to treatment tell your doctor:
- If you have significant neurologic conditions such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing
- If you have autonomic dysreflexia from a spinal cord injury as this can increase blood pressure to unsafe levels
- If you have a bleeding disorder which might increase risks of the injection procedure
- If you have a urinary tract infection as it may increase your risk for a more severe infection
- If you are pregnant or plan on becoming pregnant. Unknown risk for unborn baby
- If you are breastfeeding as it is unknown if botox passes into the breast milk
- If you have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past