Botulina treatments for bladder needs Montreal North Shore & Quebec


Botulina treatments for bladder needs Montreal North Shore & Quebec

Why Choose the Botulinum Toxin Injection?

This treatment prevents involuntary urine leakage and urgent or too frequent needs to urinate.

The injection of this toxin is offered if the oral medicines taken to control bladder contractions are poorly performing or are insufficiently effective.

This intervention is increasingly used by patients with idiopathic and overactive bladder who are refractory to medical treatment, and by patients with secondary effects of incontinence due to a neurological problem.

Botox is an expensive drug. It is now covered by the RAMQ with an application for exemption by a doctor. Botox is also generally covered by private insurance companies.

How Does This Treatment Work?

The Botulium toxin is injected into the thickness of the bladder’s wall.

Botulina reduces uncontrolled contractions of the bladder and diminishes the urgent needs by acting on the nerve endings contained within its walls. The urine leaks and the urgent desires are thus eliminated or significantly reduced.

The effect of the Botulina begins from 2 to 10 days after the injection. It works temporarily during an average of 6 to 9 months. However, there can be variations in efficiency from a patient to another.

When the effect disappears, this toxin can be re-injected as many times as necessary with an interval of 3 months between each operation.

How Does An Intravesical Injection of Botulina Work?

First, a catheter is inserted into the bladder. This gives a good anesthesia of the bladder wall after performing the intravesical instillation of Xylocaine in the bladder for a period of 30 minutes. The local anesthesia will soothe the sensation of pain, but you might perceive the sensation of touch of the needle, which can be unpleasant.

A flexible or a rigid cystoscope is inserted through the urinary channel. Your bladder is then inspected and pricked with a fine needle for 10 to 20 times in order to inject the total dose of the Botulina in the thickness of the bladder’s wall. The procedure itself takes less than 5 minutes. You can follow the whole process through the monitor screen. The initial recommended dilution is of 100 units in 10 ml of a saline solution at 0.9 %.

What Are the Risks and the Complications of Intravesical Injection of Botulina?

Some rare complications are related to the cystoscopy and to the punctures made in the bladder wall:
  • pain or discomfort during the insertion of the endoscope in the urethra or during the injections
  • visible bladder bleeding for more than 12 hours
  • urinary retention is the main side effect (decrease of the strength of the bladder that can sometimes result in a bladder blockage). However, this complication is temporarily and only lasts a few weeks to a few months. Self-catheterizations are then sometimes necessary
  • moderate fever (<38.5 °C) of less than 48 hours
  • urinal infection despite the use of antibiotic prophylaxis

No serious side effects related to the Botulinum toxin injections in the bladder have been reported in 7 years of study of this treatment.

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How to prepare for a Botulinum Toxin Injection

10 days before the injection
A urine test and a urine culture are required approximately 10 days before the injection. If the culture shows a presence of bacteria, an antibiotic treatment will be started. You will receive a notice from the secretary and a prescription. In addition, an antibiotic treatment required in advance of a period of a few days will be given the day before the operation.
Before the injection
In addition, before the injection, you will need to learn to empty your bladder by a probe (self-catheterization). This is a precaution, it does not mean that the blockage of your bladder will occur, however this precaution is essential. Treatment may be contraindicated if you are not able to do these self-catheterizations or if you refuse to learn them. When the effect of the toxin disappears, the bladder will resume normal emptying.

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