Why use these injections in the bladder?
Botulina injections are considered when oral medication is poorly tolerated, or insufficiently effective to control bladder contractions.
This procedure is increasingly used in patients with idiopathic overactive bladder, who are refractory to medical treatment, as well as in patients with incontinence secondary to a neurological problem.
- Drink plenty of water for 24 hours, especially if the urine is reddish.
- You can resume your usual activities the day after the injection.
- You should make a follow-up appointment within 4 to 8 weeks of the injection to see how well the treatment is working. As urine retention is the main concern with this procedure, a urine flow measurement (with an ultrasound of the bladder) will be proposed to assess the normal emptying of the bladder.
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How are botulina injections performed?
A flexible cystoscope is introduced through the urinary canal. The bladder is inspected and then injected with a thin needle, 10 to 20 times (to inject the appropriate total dose of botulina) into the bladder wall. The intervention itself lasts less than 5 minutes.
How does this treatment work?
Botulina reduces the uncontrolled contractions of the bladder and decreases the urgent need by acting on nerve endings contained in the wall. Urine leakage and urgent cravings are thus suppressed or considerably diminished.
The effect of Botulina begins 2 to 10 days after the injection. It works temporarily for an average of 6 to 9 months. However, there are variations in efficacy from one patient to another.
When the effect disappears, we can reinject this toxin as many times as necessary by respecting an interval between interventions, or three months between two injections.
botulina is an obviously expensive drug. He is now covered by the RAMQ by a request for exemption by a doctor. It is also usually covered by some private insurance plans.
What are the risks and complications of botulina injections?
- Pain or discomfort when passing the endoscope into the ureter or at the time of the injections.
- Bladder bleeding over 12 hours.
- Urinary retention is the main undesirable effect (the decrease in bladder strength which can sometimes lead to bladder blockage). It is however temporary from a few weeks to a few months. Self-catheterization is sometimes necessary moderate fever (<38.5 ° C) less than 48 hours.
- Possible urinary tract infection despite antibiotic prophylaxis.
- No serious side effects related to bladder injections of botulinum toxin have been reported in 7 years of study of this treatment.