BackTable / Urology / Topic / Procedure
Botox for Incontinence
Botox, or botulinum toxin, can be injected into the detrusor muscle to control symptoms of neurogenic detrusor overactivity (NDO) and overactive bladder (OAB), such as urinary incontinence. Botox is a neurotoxin that inhibits the release of acetylcholine vesicles at neuromuscular junctions. Injection of botox results in temporary flaccid muscle paralysis.
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Botox Procedure Overview
Prior to the botox procedure, it is important to ensure the patient does not have an active urinary tract infection. If the procedure is not being performed under IV sedation, the physician begins by inserting lidocaine jelly transurethrally. Physicians can utilize either a rigid cystoscopy with an injectable set up, or a flexible scope with a non-injection set up. The botox is reconstituted in sterile saline before it is injected into the detrusor muscle. A successful injection will leave a wheal under the bladder mucosa. Beginning at the midline, botox injections are made towards the right in 0.5 cm intervals until the bladder sidewall is reached. This is repeated, moving left of the midline. The next row of botox injections is 0.5-1 cm above the first row. Trainees may find it useful to add a small amount of indigo carmine to the botox, making it easier to note previous injection sites. Potential adverse effects of the botox procedure include dysphagia, blurred vision, and generalized weakness.
Botox for Incontinence Podcasts
Listen to leading physicians discuss botox for incontinence on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
Dr. Daniel Hoffman, a urogynecologist specializing in voiding dysfunction, discuss the use of Botox, sacral neuromodulation, and bulking agents in treating overactive bladders. Listen to hear more about patient selection criteria for each treatment, botox and neuromodulation procedure techniques, and treatment side effects and complications.
Botox is used to treat overactive bladder (OAB) as a result of detrusor overactivity (DO) or neurogenic detrusor overactivity (NDO). NDO may occur following a spinal cord injury or cerebrovascular accident, or it may develop alongside multiple sclerosis or Parkinson’s disease. Symptoms of DO include urinary urgency, urge incontinence, urinary frequency, and nocturia. Generally, physicians will suggest behavior modifications or antimuscarinic therapy to control overactive bladder. If these therapies fail, physicians will perform intradetrusor injection of botox.
 Orasanu, B., & Mahajan, S. T. (2013, January). The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian journal of urology : IJU : journal of the Urological Society of India. Retrieved September 17, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649594/
 Deffieux X, Fatton B, Denys P, Chartier-Kastler E, Amarenco G, Haab F, Costa P, Game X, Karsenty G, Saussine C, Ballanger P, Le Normand L, Ruffion A, Hermieu JF, Cosson M. (2014, October). [intra-detrusor injection of botulinum toxin for female refractory idiopathic overactive bladder syndrome]. Journal de gynecologie, obstetrique et biologie de la reproduction. Retrieved September 17, 2021, from https://pubmed.ncbi.nlm.nih.gov/25087018/
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