botox bladder injection information
What is it?
Botox® was approved by the FDA in the 1980s to treat certain disorders of the eye muscles and is now widely used in cosmetic surgery to treat wrinkles. It has been used in urology since the late 1990’s to treat certain disorders of the bladder and urethra. It acts by binding to the nerve endings of muscles, blocking the release of the transmitter that causes the muscles to contract. The effect is to temporarily paralyze or weaken the muscles at the site of injection.
How is it done?
During a cystoscopy the Botox® is injected through the scope at several sites into the muscle of the bladder. This generally takes approximately 30 minutes and can be done under local anesthesia in the office or general anesthesia in the hospital as an outpatient procedure.
What are the benefits?
Botox® can be used to treat incontinence or urgency/frequency caused by involuntary contractions of the bladder muscle. The benefits usually last for 6-9 months, and the procedure can be repeated, if successful. Studies have shown that roughly 2/3 of patients will benefit from this approach.
What are the risks?
Risks of cystoscopy include bleeding and infection, which are generally mild and treatable. The amount of Botox® needed to treat each individual bladder varies. If too little is injected, the symptoms may be partially treated, and a larger dose can be used at the next injection. If too much is injected, the bladder may not empty completely, requiring intermittent catheterization or an indwelling catheter.
What are the alternatives?
Biofeedback (pelvic muscle physical therapy) and anticholinergic medications such as oxybutynin (Ditropan) and tolterodine (Detrol) are used to treat urgency and urge incontinence. These options will usually have been tried without sufficient benefit before Botox® is considered. Neurostimulation of the sacral nerves (Interstim®) is another option for urgency/frequency and urge incontinence. Since that therapy is testable, reversible, long lasting, and FDA approved for urinary problems, it is usually considered before Botox®. Botox® is a more attractive alternative than catheters, major bladder surgery (bladder enlargement procedures), or just living with the problem when simpler options don’t help.
Is it covered by my insurance?
Botox® is approved for use in patients who have urinary incontinence due to a neurologic condition. This is assessed by your urologist. Urodynamic testing can help provide insight into the appropriate treatment, and help your physician understand how well it is working.
Botox® has been approved by the FDA and Medicare for injection into muscles for the treatment of leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease (e.g. multiple sclerosis (MS) or spinal cord injury (SCI) who still have leakage or experience too many side effects after an anticholinergic medication. Very few insurances will not cover Botox® and our clinic will get a prior authorization submitted. You will need to sign a waiver stating this is patient responsibility and you are financially responsible for the service.