From the Guidelines
Urinary incontinence is a common indication for cystoscopy with Botox (onabotulinumtoxinA) injection, particularly for patients with overactive bladder or urge urinary incontinence who have not responded to first-line treatments. This procedure is typically recommended for patients who have tried behavioral modifications and oral medications like anticholinergics or beta-3 agonists without adequate relief.
Key Considerations
- The standard dose is typically 100 units for overactive bladder or up to 200 units for neurogenic detrusor overactivity, as supported by the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up 1.
- Botox works by temporarily paralyzing the bladder muscle, reducing involuntary contractions that cause urgency and incontinence.
- Patients should be aware of potential side effects, including urinary tract infection and urinary retention, which may require temporary self-catheterization in some cases, as noted in the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1.
Pre-Procedural Evaluation
- Clinicians should measure post-void residual in patients with OAB prior to intradetrusor botulinum toxin therapy, as recommended by the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1.
- Patients with a post-void residual (PVR) > 100 to 200 mL should be approached with caution, as they may be at increased risk of incomplete bladder emptying and require clean intermittent catheterization (CIC) following the procedure.
Expected Outcomes
- Most patients experience significant improvement in urinary frequency, urgency, and incontinence episodes following this treatment, with effects typically lasting 6-9 months, as supported by the AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up 1.
From the Research
Indications for Cystoscopy with Botulinum Toxin (Botox) Injection
- Urinary incontinence is a common indication for cystoscopy with Botulinum toxin (Botox) injection, as evidenced by studies 2, 3, 4, 5, 6
- The procedure involves injecting Botulinum toxin into the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment 2
- Cystoscopy with Botulinum toxin injection has been shown to be an efficient and safe treatment option for patients with severe overactive bladder resistant to all conventional treatments 2
Efficacy of Botulinum Toxin Injection
- Studies have reported significant improvement in clinical and urodynamic variables, as well as quality of life, in patients with urinary incontinence and overactive bladder symptoms 2, 3, 4, 5, 6
- The procedure has been shown to increase bladder capacity, decrease the frequency of urge urinary incontinence, and improve symptoms of urgency and frequency 2, 3, 4, 5, 6
- Adverse events are generally mild, with urinary tract infections and urinary retention being the most common 2, 3, 4, 5, 6
Patient Selection and Treatment
- Candidates for Botulinum toxin injection should be warned that the effect of the toxin is transient and that repeated injections will be required to maintain the effect in the long term 5
- The optimal dose, number, and location of injections, as well as the impact on antimuscarinic regimen and clean intermittent catheterization use, are still being studied 4
- OnabotulinumtoxinA (botulinum toxin type A) is the most studied and approved brand for the treatment of urinary incontinence due to neurogenic detrusor overactivity and overactive bladder/idiopathic detrusor overactivity 5