Procedures

Intravesical botulinum toxin (Botox) injections

Why use these injections in the bladder?

Botox 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.

How are Botox injections 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 the patient may feel the sensation of touching the needle, which can be uncomfortable.

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 Botox) into the bladder wall. The intervention itself lasts less than 5 minutes.
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 some private insurance plans.
What are the risks and complications of Botox injections?
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 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 are the recommendations, if one is taking anticoagulant medication?
If the patients take anticoagulant medications (medicines that thin the blood), they will be asked to stop using them, and in some cases, they will be replaced by other drugs before injection. The medication can be started 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.

Request an Appointment

Dr. Marois is a urologist who is not a member of the Régie d’Assurance Maladie du Québec (RAMQ). As such, the clinic can not claim the RAMQ for the payment of his services. If you consult Dr Marois, you must pay for the services rendered.

Cancellation of appointment:

To ensure the smooth running of the clinic and a minimum of courtesy towards other patients and our staff, we ask you to notify us 48 hours in advance for the cancellation of a consultation, 5 working days in advance for a surgery at the office and 21 working days in advance for a major surgery. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

Change of appointment:

We understand that events occur, so we ask you to provide us with at least a 24-hour notice for any change in their appointment; we will be happy to accommodate you, the best we can. However, if you fail to inform us within this timeframe or do not show up, we will charge a $ 100 fee.

Thank you for your understanding.

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