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Carolina Continence Center

Botox: Intradetrusor Botulinum Toxin Injection 

You are undergoing an intradetrusor injection of botulinum toxin (botulism toxin into the bladder wall.)  The reason for doing this is that you have been trying medical therapy and it has failed or was not tolerated.  The procedure involves injecting botulinum toxin into the bladder wall to diminish the need to go to the bathroom.  The procedure takes about 15 minutes to perform, however, the effects take 5-10 days to diminish bladder contractions.  There is a dose response related to the need for catheterization.  Lower doses of the toxin (1 vial) typically have the lowest need for catheterization, approximately 6%; however, the duration of the toxin is approximately four to six months.  Doses of two or more vials may need to self-catheter up to 40% of the time, but the duration of the toxin is longer, typically six to nine months.  You may need to perform catheterization in order to void for these first few weeks, but bladder function returns quickly for most patients.  You may also experience more bladder infections if you are not emptying your bladder well.  The benefit is you may experience less urgency and frequency after the procedure.  There is also the possibility that the toxin may not work at all. 

 The procedure can be done in the office or in the outpatient surgery center.  In the office, you will be given an anesthetic into your bladder that will numb this area.  If requested, an additional anesthetic agent can be given (ketamine,) but you will need someone to drive you home after the procedure, and you will need to stay in the office for an hour for monitoring.  While this causes some increased sedation, you may experience dizziness and some nausea.  This typically passes with no need for further medication.  If you have PTSD (post traumatic stress disorder, ketamine is NOT recommended.)  If you have the procedure in the surgery center, you can be put to sleep or be heavily sedated.  You will need to have someone drive you home from the surgery center as well.