Health News, Obstetrics & Gynecology

Everyone is aware that Botox (botulinum toxin)  is being used and is FDA approved to remove wrinkles from the face. But the bladder?

:The toxin, produced by a bacillus, paralyzes the nerve endings to the muscles therefore relaxing the muscles of the face and removing the wrinkles.  

This same effect, relaxing the muscles in the bladder, can also be done by injecting Botox directly into the muscle of the bladder. Clinical trials have been done on the use of Botox in the bladder and the prostate. Many urologists who deal in the field of urgency-frequency and urgency control problems have already been using it as a standard of care. The studies are being done to get these drugs approved for various indications including prostate enlargement and overactive bladder.  

The techniques involved are rather simple and are basically used in those patients in which bladder relaxants or prostate drugs are ineffective in controlling their symptoms. In the case of the bladder, approximately 30 injections of Botox are made into the muscle of the bladder approximately above the triangular area of the bladder known as the trigone.  

This is continued to the dome of the bladder and laterally as far as possible. The net result is relaxation of the neuromuscular junction by inhibiting the neurotransmitters that normally go from the end of the nerves to receptor sites in the muscle.  

Since the entire bladder is not paralyzed, the frequency of bladder contractions, sense of fullness and urgency, and urinary control is improved with a very low if not nonexistent chance of producing urinary retention and the inability to void.  

Studies have also been done on prostate enlargement and direct injection of Botox into the prostate appears to relax the prostate and improve the voiding stream and the obstruction associated with benign enlargement of the prostate.  

The symptoms improved by using Botox in the prostate include frequency-urgency, urgency control, nocturia (frequent nighttime urination), and weak stream. In some cases, an overactive bladder may be associated with prostatic enlargement and by just injecting the prostate with Botox both the obstructive and the irritative symptoms associated with OAB will be resolved.  

More studies are to be done on patients with BPH and studies are shortly to begin on patients with spinal cord injury and neurogenic bladder dysfunction. I would expect these results within the next year or two.  

Patients who have symptoms of overactive bladder with urgency-frequency, urgency control, and nocturia who do not benefit from adequate bladder relaxant oral drug therapy (antimuscarinics) in the future may consider the injection of Botox into the bladder. The duration of a single course of Botox in the bladder may last six to 12 months before repeat injections will be necessary. (February 2007)

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