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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?
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
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
Nerve stimulation, also known as neuromodulation, is a treatment option for overactive bladder (OAB) if medications have not worked or you have intolerable side effects from the medications. Nerve stimulation can also be used if you have urinary symptoms that are caused by neurological conditions.
Nerve stimulation uses electrical pulses to stimulate the sacral nerves, which control the bladder and urination cycle.
PTNS uses a needle at the level of the ankle to stimulate the tibial nerves which in turn, leads to the sacral nerves.
Tibial nerve stimulation
Your doctor/nurse will place a thin needle which is connected to electric current near your ankle. The needle passes through the skin and stimulates the tibial nerve. This nerve runs from the inner part of the ankle, along the leg, up to the sacral nerves in the lower back (Fig. 1).
A treatment course for tibial nerve stimulation generally includes 12 sessions. Treatment sessions are done once a week at the clinic and usually last 20 - 30 minutes. The effect may wear off over time and you will likely need more treatment courses after the initial 12 sessions.
Risks of PTNS
PTNS is a well-tolerated procedure and has few side effects. You may feel some mild pain when the needle is being placed but this will stop once the needle is removed. During the procedure, you may feel some aching sensation when the current is running through.