Intravesical Botulinum Toxin

What is Intravesical Botulinum Toxin?

Intravesical botulinum toxin is a procedure that involves injection of Botulinum Type-A toxin (Botox) into your bladder wall to treat an overactive bladder. An overactive bladder can result in:

• Increased urinary urgency (sudden, strong desire to pass urine)
• Increased frequency of urination (number of times you urinate)
• Incontinence (uncontrolled leakage of urine)

How does Intravesical Botulinum Toxin Work?

Overactive bladder is caused by the uncontrolled or unnecessary contraction or spasming of the muscles in your bladder wall. Botox is an injectable medication produced by the bacterium Clostridium botulinum. When injected, Botox binds the nerves endings, blocking nerve impulses to the muscles in the bladder wall. This allows the muscles to relax, helps the bladder hold more urine before you feel the urge to urinate, and reduces incontinence.

Indications for Intravesical Botulinum Toxin Injections?

Intravesical Botox injections are recommended if you have:

• A proven case of overactive bladder or incontinence by investigations
• Not responded to or have not had success with other treatments
• Severe symptoms

Intravesical botulinum toxin injection is not recommended if you have:

• Current bladder infection
• Inability to urinate without a catheter
• Allergy to botulinum toxin

Preparation for Intravesical Botulinum Toxin Injection

Though you will be allowed to eat or drink as usual, your doctor will recommend the following in preparation for an intravesical botulinum toxin injection:

• Begin taking antibiotics 1 to 3 days in advance to help prevent infection
• Stop taking any antiplatelet medications three days prior to your injection
• Learn how to use a self-catheter in case you face urination issues afterward

Procedure for Intravesical Botulinum Toxin Injection

The injection is administered during a cystoscopy procedure most commonly performed under local anaesthesia in an out-patient setting. Cystoscopy is a procedure in which a cystoscope or flexible telescope with a small light and camera at its end is inserted into the bladder to provide visualisation while a procedure such as an intravesical botulinum toxin injection is performed.

You will be asked to empty your bladder prior to the cystoscopy and your urine may be tested for infection. Then, you will lie down on your back on an exam table with your feet in stirrups and your knees bent.

During the procedure:

• Your genital area is cleaned with a mild antiseptic solution.
• Anaesthetic gel is used to numb and lubricate the urethra (urinary passage)
• The cystoscope is inserted into your bladder via the urethra.
• The bladder is then filled with local anaesthetic.
• Once the anaesthetic has taken effect, a needle is inserted into the bladder.
• After careful examination, Botox is injected into the bladder wall in several locations.
• The cystoscope will then be removed to conclude the procedure.

The procedure normally takes about 15-20 minutes. The effects of Botox usually start 1-7 days after the injection and can last anywhere between 6-12 months.

Side Effects Associated with Intravesical Botulinum Toxin Injections

Botox is quite safe to use. Very rarely, however, there can be minor and short-lived side effects such as:

• Mild bleeding, blood-stained urine
• Urinary tract infection
• Difficulty urinating and need for intermittent self-catheterisation
• Headache, light-headedness
• Flu-like symptoms
• Abdominal pain

Care After Intravesical Botulinum Toxin Injection

You are advised to increase your water intake following the procedure. Self-catheterisation is recommended if you are not able to urinate. A follow-up appointment is scheduled in about 2 weeks during which a bladder scan may be performed to see how well the bladder is emptying. You are also advised to avoid driving or hazardous activity too quickly after receiving the injection.

Benefits of Intravesical Botulinum Toxin Injection

Botox injection increases the amount of urine that your bladder can hold and significantly reduces:

• Urinary urge
• Urinary frequency
• Episodes of urinary leakage