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Download The Use of Botulinum toxin in Urology
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Taking the Wrinkles out of the Bladder The Use of Botulinum Toxin in the Bladder Sharon English Urologist Christchurch After I started botoxing I just could not stop Medical Uses of Botulinum Toxin blepharospasm pelvic pain strabismus achalasia focal dystonias muscle spasms spasticity hyperhidrosis painful bladder wrinkles bladder overactivity migraine Clostridium botulinum spore prior to germination Botulinum Toxin A (Botox®) Mechanism of Action of Botulinum Toxin Mechanism of Action of Botulinum Toxin Regrowth of Axons Uses of Botulinum Toxin in Urology and Gynaecology • neuropathic bladder conditions – detrusor overactivity – detrusor sphincter dysenergia • • • • • bladder overactivity painful bladder syndrome pelvic pain outflow obstruction symptoms urinary retention Injecting Botulinum into the Bladder • 100 units diluted with 10mls of normal saline • given as 1 ml injections • dose of 100 - 300 units • spare the trigone Injecting Botulinum Toxin • Rigid cystoscope – using GA – day patient – higher doses – more precise • Flexible cystoscope – using LA – outpatient clinic – well tolerated Injecting Botulinum toxin Flexible Cystoscopy Injection of Botulinum Toxin in the Bladder Side Effects • Very rare – no severe effects reported – minor effects • dysphagia, diplopia, blurred vision • periheral muscle weakness • Contraindications – pre-existing neuromuscular conditions Bladder Overactivity • Collection of Symptoms – – – – urgency urge incontinence frequency nocturia Very common problem especially in the elderly Treating Bladder Overactivity • Treatment – – – – oxybutynin imipramine very expensive anticholinergics major surgery Now can offer Botulinum toxin if medications do not work Choosing the Botox Patient • Symptoms of urgency, urge incontinence • No UTIs • Failed/intolerant oxybutynin • No voiding dysfunction • Urodynamics Urodynamics showing Detrusor Overactivity Treating Bladder Overactivity with Botulinum Toxin • • • • • • Effects take 1-3 weeks Check residual if symptoms worsen Retention improves after 6-8 weeks UTIs Effects last 6-16 months Can repeat treatment Literature Results 100 units • Urge incontinence resolved 86% • Nocturia 4 – 1.5 • Frequency 14 – 7 • Retention 4% 200 units • Urge incontinence resolved 50% • Nocturia • Frequency 15 – 8 • Retention 37% Repeat Treatments • Effect on smooth muscle – fades after 6-12 months – axonal regeneration • Repeat treatments results in – same response – antibodies to Type A very uncommon Neurogenic Detrusor Overactivity • Occurs in – – – – spinal cord injury multiple sclerosis Parkinson’s post-stroke Neurogenic Detrusor Overactivity Neurogenic Detrusor Overactivity • 10 unit injections • Use a higher dose: 300 units • Patients already selfcatheterising Painful Bladder Syndrome • Two studies – one effective – one ineffective • Tried two patients with mixed effect • Raises questions as to how Botulinum toxin works
