This information is intended to supplement the advice already given to you by your urologist.
Key Points
- Botulinum toxin-A (Botox) bladder injections are performed to treat overactive bladder and neurogenic bladder.
- We inject Botox directly into the bladder using a telescope and camera (cystoscope) put in through your urethra (passageway through which you urinate).
- The injections can sometimes be uncomfortable, but the procedure only takes a few minutes.
- The procedure is most often performed under local anesthetic (freezing lubricant placed in the urethra) in the outpatient cystoscopy suite at Lions Gate Hospital (the “Local Room” or “Ambulatory Surgical Clinic”).
- Some patients have difficulty passing urine afterwards and you may need to use a disposable catheter (long skinny tube) to empty your bladder; this may last for several weeks or months but is rarely permanent. In some patients, the intent of Botox is to help improve the bladder volume in patients who already depend on a catheter to empty.
- The most common side effect after injection is a urinary tract infection (UTI).
Botox injections are usually effective for 4-12 months, so repeat procedures are often performed if patients are happy with the outcome.
What does the procedure involve?
Botulinum toxin-A injections are used to treat overactive bladder (OAB) and neurogenic bladder (NGB). These patients 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 flexible telescope (cystoscope) into your bladder through your urethra and injecting a small amount of botulinum-toxin A solution into the bladder wall using a tiny needle passed via the cystoscope. Depending on the dose of botulinum-toxin A used, approximately 10 sites are injected. An anesthetic lubricant is placed in the urethra before passing the cystoscope.
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 store.
Preparation before coming to the hospital
In most patients, the procedure is being done under local anesthesia so there is NO fasting. You can drive yourself.
Your surgeon may ask you to do a urine test at least 1 week prior to your procedure to rule out an infection. If you think you have an infection, let your surgeon know ASAP as the procedure might need to be postponed until the infection is treated.
Wear comfortable clothes.
For women, the procedure does not need to be postponed if menstruating.
Your surgeon will give you specific instruction on whether you will need to pick up the Botox from your pharmacy, depending on insurance coverage (Pharmacare and extended health benefits).
What to expect at the hospital
Empty your bladder in the waiting room bathroom just prior to the procedure. If you catheterize to empty your bladder, catheterize as you would normally. Your surgeon can also insert a catheter just prior to the procedure if necessary.
You will be lying on your back on the exam bed and ask to lower your pants and underwear to the ankles on the bed.
An anesthetic lubricant is put in the urethra.
A small flexible cystoscope and tiny needle passed within the cystoscope is inserted through the urethra.
Approximately 10 sites in the bladder (varies from 5-20 depending on the dose of Botox) are injected. The injections are uncomfortable but not usually very painful. This part of the procedure takes only a few minutes.
You should empty your bladder before leaving the hospital as it will have been filled partially for the procedure.
Your surgeon may give you an antibiotic after the procedure.
You can go home immediately after the procedure.
Outcomes
Botulinum toxin-A injections are effective in over 7 out of 10 patients (70%), meaning the urgency, frequency and incontinence are significantly better or even cured.
The effects of the injections last for around 4-12 months. Most people notice their symptoms returning gradually. You should let your surgeon know when you are confident the botulinum toxin-A effect is wearing off so a repeat injection can be scheduled if appropriate.
There is no limit to how many times you can have injections, and most people find that having repeat injections works well over many years.
What to expect after the procedure
Botox starts to take effect 1-3 weeks after the procedure. If you are taking a bladder medication, you can discontinue it once you feel the Botox is taking effect.
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 you surgeon’s advice about risk and their impact on you as an individual.
| After-effect | Risk |
| Symptoms return after 4-12 months, requiring repeat injections | Almost all patients |
| Mild burning on passing urine for 24 hours after the procedure | Almost all patients |
| Mild bleeding in the urine for 1-3 days after the procedure (usually very mild pink tinged urine) | Almost all patients |
| Failure of the treatment to improve overactive bladder symptoms | Around 3 in 10 patients (30%) |
| Difficulty passing urine after the procedure which may require intermittent self-catheterization (more likely with higher doses) | 1 in 5-15 patients (6-20%) |
| Infection of the bladder requiring antibiotic treatment | 1 in 6-7 patients (15%) |
| Recurrent urinary tract infections | 1 in 10-50 patients |
| Allergic reaction to Botox (with difficulty breathing, swallowing, and speaking) requiring emergency treatment | Very rare. Less than 1 in 250 patients |
| Generalized weakness of the legs and arms due to the Botox (usually settles without admission or treatment) | Very rare. Less than 1 in 250 patients. |
REFERENCE
British Association of Urological Surgeons (BAUS) Limited, June 2020.
North Shore Urology 