Intravesical botox is a procedure that involves an injection of Botulinum Type-A toxin into the muscles of the bladder wall. The toxin produced by Clostridium botulinum binds to the nerves endings and prevents the bladder muscle from contracting (squeezing) too much. This should help to treat over-activity of the bladder muscles by allowing better hold on and thus increase the amount of urine the bladder can store.
The procedure involves passing a telescope (cystoscopy) into the bladder, through the urethra, and giving several injections of Botox (Botulinum Type-A toxin) into the bladder wall.
What are the alternatives?
- Conservative treatments
- Incontinence pads – if the symptoms are not so bothersome, you may choose to do nothing and use incontinence pads for urine leakage
- Conservative measures – including weight loss, improving fluid intake and reducing caffeine and alcohol
- Bladder training – learning techniques to hold on and over-ride the urge to pass urine
Medicines - these may help if conservative treatment does not work
Botulinum toxin-A injections are usually only tried if the other treatments are not effective.
Other procedures that can be used instead of Botulinum toxin-A injections include:
• Sacral nerve stimulation – a device implanted in your lower back that sends electrical signals to the bladder nerves
• Posterior tibial nerve stimulation, Percutaneous Tibial Nerve Stimulation (electrical stimulation of a nerve near your ankle) can be used,
• Enterocystoplasty – a major operation that enlarges your bladder
About the procedure
- Local anaesthetic gel will be introduced into your urethra although, sometimes, a general anaesthetic is needed
- A cystoscope will be introduced into your bladder through your urethra and a number of Botulinum toxin-A injections will be given on your bladder wall
- Injections are not usually painful but some patients find them uncomfortable
- Patients can usually can go home shortly after the procedure
- Injections usually work within days but they can take up to two weeks to work
Botulinum toxin-A injections are effective in over 7 out of 10 patients (70%), meaning that their urgency and incontinence are either significantly better or cured. The effects of the injections last for around four to 12 months and then the symptoms start to return. As such, patients will need further injections when this happens. There is no limit to how many times of injections, and most people find that having repeated injections work well over many years.
Risks and side effects
- Symptoms return after 4 - 12 months, requiring repeated injections (common)
- Mild burning on passing urine for 24 hours after the procedure (common)
- Bleeding in the urine for 1 - 3 days after the procedure (common)
- Failure of the treatment to improve overactive bladder symptoms
- Difficulty passing urine after the procedure which may require intermittent self-catheterisation (more likely with higher doses)
- Infection of the bladder requiring antibiotic treatment
- Recurrent urinary tract infections (rare)
- Allergic reaction to Botox (with difficulty breathing, swallowing and speaking) requiring emergency treatment (very rarely)
- Generalised weakness of the legs & arms due to the Botox, usually settles without admission or treatment (very rarely)