Download Botulinum Toxin - Warwickshire Urology

Botulinum Toxin (Botox) in the treatment of the Overactive Bladder
Botulinum Toxin A is used in the treatment of Overactive bladder symptoms that has
not responded to conservative treatment.
Botulinum Toxin A is a powerful neurotoxin that acts on nerve-endings to produce
muscle paralysis. In patients with over-active bladder paralysing the bladder improves
patient symptoms and quality of life.
Botulinum Toxin A is an unlicensed product for use in the bladder. It has therefore to
be used on a named patient basis.
It is NICE approved for use in selected patients before being considered for more
radical treatment i.e. clam cystoplasty. It has been approved by the Drugs and
Therapeutic Committee locally.
Criteria to be fulfilled before patient has Botulinum Toxin A
a. The patient should have failed at least two drugs that is used to treat
bladder over-activity (either due to lack of efficacy or severe sideeffects)
b. The patient should be in a position to empty your bladder yourself
using a catheter (or your carer could do it for you) in case you are not
able to empty your bladder (catheter is a tube that is used to drain urine
from the bladder)
c. The diagnosis confirmed by urodynamics (bladder pressure studies).
d. The patient may not have an indwelling catheter at the time of the
injection.
e. There must be no signs of a urine infection at the time of the injection
f. The patient must not have any bleeding disorder or be on Warfarin at
the time of the injection.
g. The patient must be prepared to have regular follow-up appointments
h. If the effect of botox wears off the patient may need a repeat
urodynamics (bladder pressure studies)
Side-effects of Botulinum Toxin A:
These include transient flu-like symptoms; transient rash; unable to pass urine
that may last many months and would need the patient to self-catheterise (or
their carer); a few cases of muscle weakness have been reported especially in
patients with a neurological problem (i.e. multiple sclerosis). Very rare cases
of total muscle paralysis have been reported.
Botulinum Toxin A is effective in 65 – 75 % of patients. If it is successful it generally
lasts for anywhere between 6-18 months.
Botulinum Toxin A has been re-injected a few times with good result. It must be
understood that it is a new treatment modality for an over-active bladder and its longterm effects are still not clear.
The patient will have a flexible cystoscope inserted into the bladder under a local
anaesthetic.200 – 300 units of the drug is injected in 20 – 30 sites within the bladder
using a very fine needle. The procedure takes 15 minutes and is relatively painless. In
the 40 patients that we have done the patient perceived pain score was on average
3/10 (where 0 is painless and 10 is extremely painful). The patient will be given
antibiotics before and for three days after the procedure.
This treatment is available at the University Hospitals Coventry and Warwickshire in
the Urology Department and at the BMI Meriden Hospital.