Botox, also known as Botulinum A toxin or onabotulinumtoxinA, is a drug that can temporarily paralyze muscles. It has been used for broad medical applications from reducing wrinkles to treating headaches.
Botox injections into the bladder wall can effectively relieve the symptoms of overactive bladder by reducing frequency and urge incontinence leakage. The Botox serves to temporarily paralyze the bladder muscle and decrease the sensitivity of the bladder sensory nerve fibers. A cystoscope, or small telescope, is passed into the bladder through the urethra and the medication is injected with a needle passed through the cystoscope.
When to ask a Urologist about Botox injections
You should speak with a Urologist about bladder Botox injections if you have bothersome symptoms of overactive bladder that have not been effectively treated with oral medications.
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Most patients have a significant improvement in symptoms of urinary frequency and urge incontinence leakage. The procedure typically results in greater than 50% improvement for about 70% of patients. Half of patients report no remaining incontinence! The therapeutic effect is not permanent and usually lasts for about 6-8 months. Patients with good results may continue with repeat injections.
Possible Side Effects
The Botox is occasionally too effective and may temporarily impair the ability of the bladder to empty. About 5% of patients may need to perform intermittent self-catheterization temporarily for several weeks or months to help empty their bladder. The risk of Botox causing systemic weakness is extremely rare with few reported cases. Additional risks associated with cystoscopy include a small risk of urinary tract infection, blood in the urine, or minor trauma to the urethra.
Other options for the management of overactive bladder include observation without treatment, lifestyle modifications, oral medications, percutaneous tibial nerve stimulation (Urgent PC), or placement of sacral neuromodulation device (Interstim).
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The procedure takes about 10 minutes and is performed in an outpatient setting with or without light sedation. The majority of patients do very well with minimal or no side effects. Some have pain or burning during urination which typically resolves on its own within a few days. The therapeutic effects are usually not notable for about one week.