Why use these Botulina (Botox) injections in the bladder?
Botulina injections are considered when oral medication is poorly tolerated, or insufficiently effective to control bladder contractions.
This procedure is increasingly used in patients with idiopathic overactive bladder, who are refractory to medical treatment, as well as in patients with incontinence secondary to a neurological problem.
What are the indications for intravesical Botox injections?
For the treatment of urinary incontinence due to neurogenic detrusor overactivity resulting from neurogenic bladder associated with multiple sclerosis or sub-cervical spinal cord injury in adults who had an inadequate response to or are intolerant of anticholinergic medications.
For the treatment of overactive bladder with symptoms of urinary incontinence, urgency, and frequency, in adult patients who have an inadequate response to or are intolerant of anticholinergic medication.
For the treatment of overactive bladder with symptoms of urinary incontinence, urgency, and frequency, in adult patients who have an inadequate response to or are intolerant of anticholinergic medication.
How are botulina injections performed?
A urinary catheter is introduced into the bladder. A good anesthesia of the bladder wall is obtained after instillation of intravesical Xylocaine into the bladder, for a period of 15 to 30 minutes. Local anesthesia removes the feeling of pain, but the patient may feel the sensation of touching the needle, which can be uncomfortable.
A flexible cystoscope is introduced through the urinary canal. The bladder is inspected and then injected with a thin needle, 10 to 20 times (to inject the appropriate total dose of botulina) into the bladder wall. The intervention itself lasts less than 5 minutes.
A flexible cystoscope is introduced through the urinary canal. The bladder is inspected and then injected with a thin needle, 10 to 20 times (to inject the appropriate total dose of botulina) into the bladder wall. The intervention itself lasts less than 5 minutes.
How does this treatment work?
Botulinum toxin A (Botulina) is injected into the thickness of the bladder wall.
Botulina reduces the uncontrolled contractions of the bladder and decreases the urgent need by acting on nerve endings contained in the wall. Urine leakage and urgent cravings are thus suppressed or considerably diminished.
The effect of Botulina begins 2 to 10 days after the injection. It works temporarily for an average of 6 to 9 months. However, there are variations in efficacy from one patient to another.
When the effect disappears, we can reinject this toxin as many times as necessary by respecting an interval between interventions, or three months between two injections.
botulina is an obviously expensive drug. He is now covered by the RAMQ by a request for exemption by a doctor. It is also usually covered by some private insurance plans.
Botulina reduces the uncontrolled contractions of the bladder and decreases the urgent need by acting on nerve endings contained in the wall. Urine leakage and urgent cravings are thus suppressed or considerably diminished.
The effect of Botulina begins 2 to 10 days after the injection. It works temporarily for an average of 6 to 9 months. However, there are variations in efficacy from one patient to another.
When the effect disappears, we can reinject this toxin as many times as necessary by respecting an interval between interventions, or three months between two injections.
botulina is an obviously expensive drug. He is now covered by the RAMQ by a request for exemption by a doctor. It is also usually covered by some private insurance plans.
What are the risks and complications of botulina injections?
Some rare complications are related to cystoscopy and stings made in the bladder wall:
- Pain or discomfort when passing the endoscope into the ureter or at the time of the injections.
- Bladder bleeding over 12 hours.
- Urinary retention is the main undesirable effect (the decrease in bladder strength which can sometimes lead to bladder blockage). It is however temporary from a few weeks to a few months. Self-catheterization is sometimes necessary moderate fever (<38.5 ° C) less than 48 hours.
- Possible urinary tract infection despite antibiotic prophylaxis.
- No serious side effects related to bladder injections of botulinum toxin have been reported in 7 years of study of this treatment.
What are the recommendations, if one is taking anticoagulant medication?
If the patients take anticoagulant medications (medicines that thin the blood), they will be asked to stop using them, and in some cases, they will be replaced by other drugs before injection. The medication can be started again after the injection. This relay will be in accordance with the instructions given by your referring doctor or by your cardiologist. You must strictly respect the dates of stop and resume of your medication.