Intravesical Botulinum Toxin Type A Injection

What is intravesical Botulinum toxin type A injection?

Botulinum toxin type A has been a proven agent in clinical use since 1990. It is routinely used in facial aesthetic treatments, as well as for a wide range of medical indications, such as blepharospasm and other forms of dystonia, focal spasm, migraine, hyperhidrosis, and in the treatment of other medical conditions.

What are the indications for intravesical Botulinum toxin type A therapy? 

In urogynecology and urology, Botulinum toxin type A therapy is used for the following bladder disorders:

• Idiopathic overactive bladder with symptoms of urinary incontinence, urgency and frequent urination in adult patients who have not responded adequately to or are intolerant of anticholinergic medications.
• Urinary incontinence in adults with neurogenic detrusor overactivity resulting from neurogenic bladder due to stable supracervical spinal cord injury or multiple sclerosis.

How is intravesical Botulinum toxin therapy performed? 

In the management of urinary incontinence, Botulinum toxin should be administered by physicians experienced in the assessment and treatment of bladder dysfunction (e.g., urogynecological subspecialists and urologists).

Before injection, either intravesical instillation of a diluted anesthetic (with or without sedation) or short-term general anesthesia should be administered according to established practice. If local intravesical instillation of anesthetic is used, the bladder should be drained and flushed with sterile saline prior to the next steps in the injection procedure. The bladder should be instilled with saline in a sufficient volume to achieve adequate visualization for injections, but excessive distension should be avoided.

Botulinum toxin (100 or 200 units diluted in sterile saline) is injected into the detrusor muscle using a flexible or rigid cystoscope, avoiding the trigone and base. With a needle inserted into the detrusor, the solution is injected through 20-30 injections. After injection, the saline used to visualize the bladder wall should not be drained so that patients can demonstrate the ability to urinate before leaving the hospital. The patient should be observed for at least 30 minutes after injection and until spontaneous urination occurs.

When can clinical improvement be expected after intravesical Botulinum toxin type A injection? 

Clinical improvement can be expected within 2 weeks. Re-injection may be considered when the clinical effect of the previous injection in the patient has diminished, usually after 6-12 months, depending on the diagnosis and the dose administered, but not earlier than 3 months after the previous bladder injection.