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Procedures

Intravesical botulinum toxin injection service

Why use these botox injections in the bladder?

This treatment makes it possible to avoid urine leakage and urges to urinate urgently or too frequently.

Botox intravesical injections are offered when the medications you take orally are poorly supported or insufficiently effective to control bladder contractions.

This procedure is increasingly used in patients with idiopathic overactive bladder who are refractory to medical treatment and in patients with incontinence secondary to a neurological problem.

How a botox intravesical injections is performed?
A urinary catheter is introduced into the bladder. A good anesthesia of the bladder wall is obtained after instillation of intravesical Xylocaine into the bladder for a period of 15 to 30 minutes. Local anesthesia removes the feeling of pain, but you may feel the sensation of touching the needle, which can be uncomfortable.

A flexible or rigid cystoscope is introduced through the urinary canal. Your bladder is inspected and then injected with a thin needle 10 to 20 times to inject the appropriate total dose of Botox into the wall thickness. The intervention itself lasts less than 5 minutes. You can follow it on the control screen if you wish. The initial recommended dilution is 100 units diluted in 10 ml of 0.9% saline.
How does this treatment work?
Botulinum toxin A (Botox) is injected into the thickness of the bladder wall.

Botox 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 Botox 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.

Botox 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 private insurance.
What are the risks and complications of an intravesical Botox injection?
Some rare complications are related to cystoscopy and stings made in the bladder wall:
  • Pain or discomfort when passing the endoscope into the ureter or at the time of the injections.
  • Bladder bleeding visible 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.
What to do if taking anticoagulant medications?
If you take anticoagulant medications (medicines that thin the blood), you will be asked to stop using them, and in some cases, they will be replaced by other drugs before injection. You can start taking your medication again after the injection. This relay will be in accordance with the instructions given by your referring doctor or by your cardiologist. You must strictly respect the dates of stop and resume of your medication.

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