Background Information:

What are the other Names for the Procedure?

• Botox for Overactive Bladder
• Botox Injections for Overactive Bladder
• Botulinum Toxin A for Overactive Bladder

What is Botox Treatment for Overactive Bladder?

• Botox Treatment for Overactive Bladder is a procedure in which botulinum toxin A injections are directly injected into the urinary bladder to treat symptoms of an overactive bladder
• An overactive bladder (OAB) is a urological condition that results in a sudden frequent urge to urinate, resulting in the involuntary spillage of urine. It is commonly seen in adults
• It is believed that the condition occurs when there is loss of control over urination due to neurological impairment resulting in poor control over the urinary bladder muscles
• Botox Injections for Overactive Bladder are an effective treatment option which can help control urinary muscle spasms, thereby reducing the symptoms of OAB and providing relief to the affected individual for periods ranging from 6 to 9 months

What part of the Body does the Procedure involve?

Botox Treatment for Overactive Bladder involves the urinary bladder, urethra, and the genitalia.

Why is the Botox Treatment for Overactive Bladder Performed?

Botox Treatment for Overactive Bladder is performed to treat an overactive bladder (OAB), when other treatment measures have been unsuccessful. The procedure is performed for the following reasons:

• To improve the symptoms of OAB that include a sudden urge to urinate, regular night-time urination causing disturbed sleep, and avoidance of involuntary urine loss/leakage resulting in wetting. Studies show that Botox injections can help a majority of the individuals (over 75% of them) with OAB
• When the use of anticholinergic agents (medications that inhibit the neurotransmitter acetylcholine in the nervous system) to treat OAB has not proven to be effective
• When the patient cannot tolerate surgical procedures

What are some Alternative Choices for the Procedure?

Some of the alternatives to Botox Treatment for Overactive Bladder include the following measures:

• Administration of medication to relax or contract the bladder muscles
• Nerve stimulation through minimally-invasive procedures
• Surgery to increase urinary bladder volume using graft tissue from other parts of the body
• Reconstructive surgical procedures for urinary bladder, for severe OAB

Alternatives to Botox for Overactive Bladder may be considered in individuals who do not tolerate Botox injections.

What are the Recent Advances in the Procedure?

Recent advances to Botox Treatment for Overactive Bladder are with respect to the composition and delivery mechanisms of botulinum toxin A injections.

What is the Cost of performing Botox Treatment for Overactive Bladder?

The cost of Botox Treatment for Overactive Bladder depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Botox Treatment for Overactive Bladder and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://healthcare.utah.edu/urology/services/botox.php (accessed on 03/09/2018)

http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Womenshealth/Botox-treatment-for-an-overactive-bladder-patient-information.pdf (accessed on 03/09/2018)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810204/ (accessed on 03/09/2018)

Prior to Botox Treatment for Overactive Bladder:

How is the Botox Treatment for Overactive Bladder Performed?

Botox Treatment for Overactive Bladder may be undertaken in the following manner:

• The procedure is performed by applying a local anesthetic agent to the pelvic site. Occasionally, the individual may be administered general anesthesia
• The inside of the urinary bladder is explored by the urologist by inserting a cystoscope, which is a thin tube having a tiny camera at its end
• Botox injections are then administered to the targeted site (urinary bladder walls), through the thin tube; several injections may be given during a session
• Following the procedure, the individual is placed under observation for a period of time, until they first pass urine. In some cases, hospitalization may be necessary and the patient may be asked to stay overnight

Where is the Procedure Performed?

Botox Treatment for Overactive Bladder is usually performed in an out-patient (surgery) facility, a physician’s clinic/office, or a hospital.

Who Performs the Procedure?

An urologist usually performs the Botox Treatment for Overactive Bladder.

How long will the Procedure take?

The time taken for the Botox Treatment for Overactive Bladder procedure may be around 10-15 minutes. However, following the injection, the patient is monitored for a period of about half an hour. Post procedure, there is also a wait time involved, until the patient first urinates.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Botox Treatment for Overactive Bladder and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Botox Treatment for Overactive Bladder using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Botox Treatment for Overactive Bladder?

The following exams and tests may be recommended prior to the Botox Treatment for Overactive Bladder:

• Routine blood and urine analysis
• Blood urea and serum creatine levels to examine kidney function
• Kidney function study
• Cystoscopy

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is Botox Treatment for Overactive Bladder?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Botox Treatment for Overactive Bladder:

What kind of Anesthesia is given, during the Procedure?

In a majority of cases, local anesthesia is administered during the procedure. However, in some rare cases, the procedure may be performed under general anesthesia.

How much Blood will you lose, during the Procedure?

There may be minimal blood loss involved during Botox Treatment for Overactive Bladder.

What are the possible Risks and Complications during Botox Treatment for Overactive Bladder?

There are general factors that increase the risk of complications during the procedure and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible complications that may arise during the procedure are:

• Infection
• Accidental injury to the neighboring tissue, blood vessel, nerve, or bone
• Side effects of Botox, which may be immediate and severe in some individuals

What Post-Operative Care is needed at the Healthcare Facility after Botox Treatment for Overactive Bladder?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Botox Treatment for Overactive Bladder:

What are the possible Risks and Complications after Botox Treatment for Overactive Bladder?

Significant risks and complications are generally not noted after a Botox Treatment for Overactive Bladder, in a majority of individuals. However, in some cases, there may be serious side effects of Botox injections that include:

• Difficulty in breathing and swallowing
• Toxic effects of Botox, such as hoarse voice, vision impairment, full body muscle weakness, and loss of bladder function
• In rare cases, an immediate allergic reaction has been reported that can be even life-threatening

In some individuals (about 5% of the cases), urinary retention or difficulty in urinating completely, may be observed. However, this is normally noted to be a temporary fall-out of the procedure. In women, there is also an increased risk of urinary tract infection, according to studies.

What is the Prognosis after the Procedure?

• The prognosis after a Botox Treatment for Overactive Bladder is usually excellent for a majority of individuals; the symptoms of OAB subside within 4-7 days
• However, Botox injection therapy is only a temporary treatment method and its effectiveness only lasts for a period of 6-9 months. Thus, the injections have to be administered again (repeat procedure) to control symptoms of OAB

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling around the injection site
• Bleeding or fluid drainage from the site
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, or constipation
• Experiencing difficultly or pain while urinating
• Presence of blood in urine
• Signs of an infection
• Headache, muscle aches
• Fever, feeling sick
• Dizziness
• Side effects of the injection including muscle weaknesses and swallowing/speaking/breathing difficulties

What Post-Operative Care is needed at Home after Botox Treatment for Overactive Bladder?

At home, the following post-operative care is recommended after a Botox Treatment for Overactive Bladder:

• Follow instructions and take medications prescribed by the urologist
• Take stool softeners to prevent constipation, under advice of the physician; have soft foods for a few days
• Avoid all activities that are physically strenuous for about 2 weeks after the surgery (per physician’s advice)
• Avoid sex till a complete healing has taken place (as advised by your physician)
• Avoid taking nonprescription medications
• Avoid smoking or chewing tobacco
• Eat healthy food rich in vegetables and whole grains

How long does it normally take to fully recover, from the Procedure?

In a majority of cases, individuals are able to fully recover from the procedure within a few days to a week.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, the procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, no tissue is sent for a pathological analysis.

Who will you receive a Bill from, after the Botox Treatment for Overactive Bladder?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist
• An urologist

The patient is advised to inquire and confirm the type of billing, before the Botox Treatment for Overactive Bladder is performed.