From the Guidelines
Cystoscopy with Botox injection is not a first-line indication for urinary incontinence post radical prostatectomy, but may be considered in patients with bothersome stress urinary incontinence that persists despite conservative therapy. According to the AUA/SUFU guideline 1, patients undergoing radical prostatectomy should be informed that incontinence is expected in the short-term and generally improves to near baseline by 12 months after surgery, but may persist and require treatment. The guideline recommends that surgery may be considered as early as six months if incontinence is not improving despite conservative therapy (Conditional Recommendation; Evidence Level: Grade C) 1.
Key Considerations
- Patients should first try conservative approaches such as pelvic floor exercises, behavioral modifications, and medications before considering Botox injections or other surgical options.
- Urodynamic testing is usually recommended to confirm the type of incontinence and ensure that Botox is an appropriate treatment option.
- Potential side effects of Botox injections include urinary retention, urinary tract infections, and hematuria, and patients should be aware of these risks before proceeding with treatment.
Treatment Approach
- The standard dose of onabotulinumtoxinA (Botox) for treating urinary incontinence ranges from 100-200 units, with effects lasting approximately 6-9 months, requiring repeat treatments.
- Botox injections work by temporarily paralyzing the bladder muscle, reducing involuntary contractions that contribute to incontinence.
- While not first-line therapy, Botox injections can significantly improve quality of life for men with persistent incontinence following prostate surgery when other options have been unsuccessful, as supported by the AUA/SUFU guideline 1.
From the Research
Urinary Incontinence Post Radical Prostatectomy
- Urinary incontinence after radical prostatectomy is a significant complication that can severely impact a patient's quality of life 2, 3.
- Various treatment options are available, including conservative measures such as pelvic floor physical therapy, biofeedback, and medication, as well as surgical procedures like artificial urinary sphincter placement, male slings, and bulking therapy 4, 5.
Surgical Management
- The choice of surgical procedure depends on the degree of incontinence, prior radiation therapy, and comorbidities 4.
- Artificial urinary sphincter placement is considered the gold standard for post-prostatectomy incontinence, but it has a high rate of re-operation and requires good manual dexterity 4.
- Male slings and proACT are less invasive options for mild to moderate incontinence, especially in patients without prior radiation therapy 4.
Cystoscopy with Botox (OnabotulinumtoxinA) Injection
- There is no direct evidence in the provided studies to support the use of cystoscopy with Botox (onabotulinumtoxinA) injection as a treatment for urinary incontinence post radical prostatectomy.
- The studies focus on other treatment options, such as surgical procedures and conservative measures, but do not mention Botox injection as a viable treatment for this condition 2, 4, 3, 5, 6.