What is Botulinum toxin?

Botulinum toxin ("Botox") is a neurotoxin that blocks nerve impulses to any muscles into which it has been injected.

How does it work?

It works by temporarily paralysing and relaxing the muscles in the bladder so that they no longer contract involuntarily. This increases the bladder capacity so that women can go several hours without needing to pass urine. When effective (in more then 80% of cases), the results are dramatic. However, the procedure needs to be repeated after the effect of the toxin wears off (on average every 9 months).

When is it used?

This treatment is suitable for women with severe urgency, frequency, and urge-incontinence that is unresponsive to other treatment, such as bladder retraining and medications.

Botulinum toxin injections into the bladder are used in patients with proven Over-Active Bladder (OAB), that has been demonstrated through urodynamic investigation.

What does the operation involve?

The operation takes approximately 10 minutes and is done as a day-case procedure. It is usually well tolerated under local anaesthesia, but for some women a general anaesthetic may be the preferred option. A very fine needle is inserted into the bladder through a cystoscope (small telescope), and the diluted Botulinum toxin is then injected into 15-20 sites in the bladder wall.

What are the side-effects?

The injections sometimes can over-relax the bladder, making it difficult for the bladder to empty itself completely. This happens in about 5 patients out of 100. The risk of this happening is minimised if very low doses of Botulinum toxin are used, but the lower dose also has a higher failure rate; we tailor the dose of the Botulinum toxin according to individual patient circumstances. If urinary retention occurs bladder function will eventually return to normal once the effect of treatment wears off, this can take 6-12 months. Meanwhile, our specialist nurses will teach the patient how to manage this problem, if it occurs.

What is the recovery after surgery like?

The procedure is performed as a day-case, usually in our out-patient treatment facility. Some women may experience discomfort when passing urine for 24-48 hours following the operation and may find traces of blood in the urine. A small number of patients (1 in 100) will develop a urinary tract infection, which can be treated with a course of antibiotics. Drinking plenty of fluid after the operation should prevent these problems.

Further information

For more information about recovering from the operation, and what to expect on going home, click this link: Botulinum Toxin A for overactive bladder

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Fine 4mm needle used for injections