Injection of Botox into the Bladder

Botulinum toxin (Botox) is a naturally occurring toxin produced by some bacteria. The toxin causes muscle paralysis. Small quantities of Botox can be injected into selected muscles to reduce the side effects caused by unwanted or excessive muscle contraction.

The bladder muscle can be unnecessarily 'overactive' in some patients. This is usually manifest by frequency and urgency of urination and sometimes urinary incontinence. Patients with neurological abnormalities such as spinal cord injury or multiple sclerosis may experience similar symptoms. If treatment with anticholinergic tablets such as Oxybutynin or Solifenacin do not provide adequate relief then injection of Botox into the bladder may be recommended. Botox is injected via a telescope, usually under a general anaesthetic. The effect usually takes several weeks to become noticeable and may last for up to 12 months. Following this further Botox may be required. The dose of Botox varies between 100units and 300units and depends upon the indication and previous response to Botox.

Procedure

A general anaesthetic is administered. A cystoscope is inserted through the urethra into the bladder. Using a long needle attached to a syringe Botox is injected into the bladder muscle at multiple locations throughout the bladder. A temporary catheter may sometimes be left in place following the procedure.

Pre-procedure

Aspirin, clopidogrel, dabigatran, warfarin and any other blood thinning medications will need to be stopped prior to surgery. We will advise you on the timing of when to stop and re-start these medications. A urine sample needs to be provided to the laboratory 1 week prior to surgery.

Post-procedure

You will be free to head home eater on the day of surgery or the next day. We like to be certain that you are voiding satisfactorily before discharge. You may notice some blood in the urine and more significant urinary urgency for several days following surgery. The most common adverse event is incomplete bladder emptying. This is unlikely however if this occurs then you may require a period of temporary intermittent self catheterisation before resuming spontaneous complete voiding.

Return to work

Most people can return to work within one week of Botox injection.

Follow up

I will see you three months following surgery to assess your recovery and response to Botox.

Other Risks

Risks recognised as common or serious are listed below but this does not include the rare and extraordinary.

• Urinary infection
• Spread of Botox beyond the bladder causing generalised muscle weakness is very rare. This may result in symptoms such as weakness, double vision, breathing difficulties and difficulty swallowing.