What does this procedure involve?
Botox injections are used to treat overactive bladder (OAB). Patients with OAB have a sudden, strong feeling of needing to pass urine (urgency) and sometimes urine leakage (incontinence) associated with urgency. Usually, patients need to pass urine frequently. The procedure is not a treatment for stress urinary incontinence (leakage of urine when you exercise, sneeze or strain).
The procedure involves passing a telescope into your bladder, through your urethra (waterpipe), and giving multiple injections of Botox (botulinum toxin-A) into your bladder wall. Botox prevents your bladder muscle from contracting (squeezing) too much. This should help you to hold on better and will increase the amount of urine your bladder can hold.
Prior to the procedure you will learn to self catheterise in cause you cannot pass urine post operatively.
What are the alternatives?
Overactive bladder can be treated without having an operation. We recommend that all patient try conservative treatments before having an operation because this avoids the risk of side-effects or complications of surgery.
- Incontinence pads – if your symptoms are not a bother, you may choose to do nothing and use incontinence pads for urine leakage
- Conservative measures – including weight loss, improving fluid intake and reducing caffeine
- Bladder training – learning techniques to hold on and over-ride your urge to pass urine
- Medicines – these may help if conservative treatment does not work
- Pelvic Floor Physiotherapy
Botox injections are usually only tried if the treatments are not effective. Other procedures that can be used instead of Botox injections include:
- Acupuncture and Posterior tibial nerve stimulation, PTNS (electrical stimulation of a nerve near your ankle) can be used.
- Sacral nerve stimulation – a device implanted in your lower back that sends electrical signals to the bladder nerves
- Enterocystoplasty – a major operation that enlarges your bladder using a piece of bowel
What happens on the day of the procedure?
You will be seen by Dr McMurray and the anaesthetist who will go through the plans for your operation with you.
Details of the procedure
- we normally use a local anaesthetic gel squirted into your urethra (waterpipe) although, sometimes, a general anaesthetic is needed (i.e. with you asleep)
- we put a telescope into your bladder through your urethra and give a number of injections of Botox into your bladder wall (pictured above)
- the injections are not usually painful but some patients find them uncomfortable
- you can usually go home shortly after the procedure
- the injections usually work very quickly but, sometimes, they can take up to two weeks to work
How effective is the procedure in curing stress urinary incontinence?
Botox injections are effective in over seven out of 10 patients (70%), meaning that their urgency and incontinence are either significantly better or cured. The effects of the injections last for around six to 12 months and then your symptoms start to return. You can have further injections when this happens. There is no limit to how many times you can have Botox injections, and most people find that having repeat injections works well over many years.
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask Dr McMurray’s advice about the risks and their impact on you as an individual:
What is my risk of a hospital-acquired infection?
Your risk of getting an infection in hospital is approximately 8 in 100 (8%), this includes getting MRSA or a Clostridium difficile bowel infection. This figure is higher if you are in a “high-risk” group of patients such as patients who have had:
- long-term drainage tubes (e.g. catheters);
- bladder removal;
- long hospital stays; or
- Multiple hospital admissions
What can I expect when I get home?
- you will be given advice about your recovery at home
- you will be given a copy of your discharge summary and a copy will also be sent to your GP
- if you have had a bladder catheter inserted, we will arrange an appointment for it to be removed
- you can return to normal daily life almost immediately
- you may return to work when you are comfortable enough
General information about surgical procedures
Before your procedure:
Please tell a member of the medical team if you have:
- an implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft);
- a regular prescription for a blood thinning agent (warfarin, aspirin, clopidogrel, rivaroxaban or dabigatran);
- a present or previous MRSA infection; or
Before you go home
We will tell you how the procedure went and you should:
- make sure you understand what has been done;
- ask Dr McMurray if everything went as planned;
- let the staff know if you have any discomfort;
- ask what you can (and cannot) do at home;
- make sure you know what happens next; and
- ask when you can return to normal activities.
The ward will give you advice about what to look out for when you get home. Dr McMurray or your nurse will also give you details of who to contact, and how to contact them, in the event of problems.