Why Choose the Botulinum Toxin Injection?
This treatment prevents involuntary urine leakage and urgent or too frequent needs to urinate.
The injection of this toxin is offered if the oral medicines taken to control bladder contractions are poorly performing or are insufficiently effective.
This intervention is increasingly used by patients with idiopathic and overactive bladder who are refractory to medical treatment, and by patients with secondary effects of incontinence due to a neurological problem.
How Does This Treatment Work?
The Botulium toxin is injected into the thickness of the bladder’s wall.
Botox reduces uncontrolled contractions of the bladder and diminishes the urgent needs by acting on the nerve endings contained within its walls. The urine leaks and the urgent desires are thus eliminated or significantly reduced.
The effect of the Botox begins from 2 to 10 days after the injection. It works temporarily during an average of 6 to 9 months. However, there can be variations in efficiency from a patient to another.
When the effect disappears, this toxin can be re-injected as many times as necessary with an interval of 3 months between each operation.
Botox is an expensive drug. It is now covered by the RAMQ with an application for exemption by a doctor. Botox is also generally covered by private insurance companies.
What to Do Before an Intravesical Injection of Botox ?
Urine analysis and urine culture are required 10 days before the procedure. If the culture shows the presence of bacteria, antibiotic treatments will be given to the patient. You will receive a notice from the secretary and a prescription. You will be required to undergo antibiotic treatment the night before the injection and during the following days.
If you are taking anticoagulants medications (blood thinning drugs), you will be asked to stop taking your medicine. In some cases, they will be replaced by other drugs for the period of time prior to the injection. You will be able to start taking your medication once again after the injection. This exchange of drugs will be followed in accordance with the instructions given by your referring doctor or cardiologist. It is important to strictly adhere to these procedures.
Before the injection, you will also need to learn to empty your own bladder through a catheter (self-catheterization). This is a precaution; it does not mean that your bladder will be blocked. This precaution is very important. This procedure can be not appropriate and also contraindicated if you are not able to make these self-catheterization or if you refuse to learn them. When the effects of the toxin disappear, your bladder will resume its normal emptying.
How Does An Intravesical Injection of Botox Work?
First, a catheter is inserted into the bladder. This gives a good anesthesia of the bladder wall after performing the intravesical instillation of Xylocaine in the bladder for a period of 30 minutes. The local anesthesia will soothe the sensation of pain, but you might perceive the sensation of touch of the needle, which can be unpleasant.
A flexible or a rigid cystoscope is inserted through the urinary channel. Your bladder is then inspected and pricked with a fine needle for 10 to 20 times in order to inject the total dose of the Botox in the thickness of the bladder’s wall. The procedure itself takes less than 5 minutes. You can follow the whole process through the monitor screen. The initial recommended dilution is of 100 units in 10 ml of a saline solution at 0.9 %.
What Are the Risks and the Complications of Intravesical Injection of Botox?
Some rare complications are related to the cystoscopy and to the punctures made in the bladder wall:
No serious side effects related to the Botulinum toxin injections in the bladder have been reported in 7 years of study of this treatment.
What Are the Recommendations after a Botox Intravesical Injection?
Drink plenty of water for 24 hours, especially if the urine is of a red colour.
You can resume your normal activities the day after the injection.
You will need to take a follow-up appointment within 4 to 8 weeks following the injection in order to judge the effectiveness of the treatment with flow measurements and with ultra sound. We will also evaluate your bladder emptying processes.
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