Title: Taking the Wrinkles out of the Bladder The Use of Botulinum Toxin in the Bladder
1Taking the Wrinkles out of the BladderThe Use
of Botulinum Toxin in the Bladder
- Sharon English
- Urologist
- Christchurch
2After I started botoxing I just could not stop
3Medical Uses of Botulinum Toxin
- blepharospasm pelvic pain
- strabismus
- achalasia focal dystonias
- muscle spasms
- spasticity
wrinkles - hyperhidrosis bladder
overactivity -
- painful bladder migraine
4Clostridium botulinum spore prior to germination
5Botulinum Toxin A (Botox)
6Mechanism of Action of Botulinum Toxin
7Mechanism of Action of Botulinum Toxin
8Regrowth of Axons
9Uses of Botulinum Toxin in Urology and Gynaecology
- neuropathic bladder conditions
- detrusor overactivity
- detrusor sphincter dysenergia
- bladder overactivity
- painful bladder syndrome
- pelvic pain
- outflow obstruction symptoms
- urinary retention
10Injecting Botulinum into the Bladder
- 100 units diluted with 10mls of normal saline
- given as 1 ml injections
- dose of 100 - 300 units
- spare the trigone
11Injecting Botulinum Toxin
- Rigid cystoscope
- using GA
- day patient
- higher doses
- more precise
- Flexible cystoscope
- using LA
- outpatient clinic
- well tolerated
12Injecting Botulinum toxin
13Flexible Cystoscopy
14Injection of Botulinum Toxinin the Bladder
15Side Effects
- Very rare
- no severe effects reported
- minor effects
- dysphagia, diplopia, blurred vision
- periheral muscle weakness
- Contraindications
- pre-existing neuromuscular conditions
16Bladder Overactivity
- Collection of Symptoms
- urgency
- urge incontinence
- frequency
- nocturia
- Very common problem especially in the elderly
17Treating Bladder Overactivity
- Treatment
- oxybutynin
- imipramine
- very expensive anticholinergics
- major surgery
- Now can offer Botulinum toxin if medications do
not work
18Choosing the Botox Patient
- Symptoms of urgency, urge incontinence
- No UTIs
- Failed/intolerant oxybutynin
- No voiding dysfunction
- Urodynamics
19Urodynamics showing Detrusor Overactivity
20Treating Bladder Overactivitywith Botulinum Toxin
- Effects take 1-3 weeks
- Check residual if symptoms worsen
- Retention improves after 6-8 weeks
- UTIs
- Effects last 6-16 months
- Can repeat treatment
21Literature Results
- 100 units
- Urge incontinence resolved 86
- Nocturia 4 1.5
- Frequency 14 7
- Retention 4
- 200 units
- Urge incontinence resolved 50
- Nocturia
- Frequency 15 8
- Retention 37
22Repeat Treatments
- Effect on smooth muscle
- fades after 6-12 months
- axonal regeneration
- Repeat treatments results in
- same response
- antibodies to Type A very uncommon
23Neurogenic Detrusor Overactivity
- Occurs in
- spinal cord injury
- multiple sclerosis
- Parkinsons
- post-stroke
24Neurogenic Detrusor Overactivity
25Neurogenic Detrusor Overactivity
- 10 unit injections
- Use a higher dose 300 units
- Patients already self-catheterising
26Painful Bladder Syndrome
- Two studies
- one effective
- one ineffective
- Tried two patients with mixed effect
- Raises questions as to how Botulinum toxin works