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Taking the Wrinkles out of the Bladder The Use of Botulinum Toxin in the Bladder

Taking the Wrinkles out of the Bladder The Use of Botulinum Toxin in the Bladder. Sharon English Urologist Christchurch. After I started botoxing I just could not stop. Medical Uses of Botulinum Toxin. blepharospasm pelvic pain strabismus

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Taking the Wrinkles out of the Bladder The Use of Botulinum Toxin in the Bladder

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  1. Taking the Wrinkles out of the BladderThe Use of Botulinum Toxin in the Bladder Sharon English Urologist Christchurch

  2. After I started botoxing I just could not stop

  3. Medical Uses of Botulinum Toxin blepharospasm pelvic pain strabismus achalasia focal dystonias muscle spasms spasticity wrinkles hyperhidrosis bladder overactivity painful bladder migraine

  4. Clostridium botulinum spore prior to germination

  5. Botulinum Toxin A(Botox®)

  6. Mechanism of Action of Botulinum Toxin

  7. Mechanism of Action of Botulinum Toxin

  8. Regrowth of Axons

  9. Uses of Botulinum Toxin in Urology and Gynaecology • neuropathic bladder conditions • detrusor overactivity • detrusor sphincter dysenergia • bladder overactivity • painful bladder syndrome • pelvic pain • outflow obstruction symptoms • urinary retention

  10. Injecting Botulinum into the Bladder • 100 units diluted with 10mls of normal saline • given as 1 ml injections • dose of 100 - 300 units • spare the trigone

  11. Rigid cystoscope using GA day patient higher doses more precise Flexible cystoscope using LA outpatient clinic well tolerated Injecting Botulinum Toxin

  12. Injecting Botulinum toxin

  13. Flexible Cystoscopy

  14. Injection of Botulinum Toxinin the Bladder

  15. Side Effects • Very rare • no severe effects reported • minor effects • dysphagia, diplopia, blurred vision • periheral muscle weakness • Contraindications • pre-existing neuromuscular conditions

  16. Bladder Overactivity • Collection of Symptoms • urgency • urge incontinence • frequency • nocturia Very common problem especially in the elderly

  17. Treating Bladder Overactivity • Treatment • oxybutynin • imipramine • very expensive anticholinergics • major surgery Now can offer Botulinum toxin if medications do not work

  18. Choosing the Botox Patient • Symptoms of urgency, urge incontinence • No UTIs • Failed/intolerant oxybutynin • No voiding dysfunction • Urodynamics

  19. Urodynamics showing Detrusor Overactivity

  20. Treating Bladder Overactivitywith Botulinum Toxin • Effects take 1-3 weeks • Check residual if symptoms worsen • Retention improves after 6-8 weeks • UTIs • Effects last 6-16 months • Can repeat treatment

  21. 100 units Urge incontinence resolved 86% Nocturia 4 – 1.5 Frequency 14 – 7 Retention 4% 200 units Urge incontinence resolved 50% Nocturia Frequency 15 – 8 Retention 37% Literature Results

  22. Repeat Treatments • Effect on smooth muscle • fades after 6-12 months • axonal regeneration • Repeat treatments results in • same response • antibodies to Type A very uncommon

  23. Neurogenic Detrusor Overactivity • Occurs in • spinal cord injury • multiple sclerosis • Parkinson’s • post-stroke

  24. Neurogenic Detrusor Overactivity

  25. Neurogenic Detrusor Overactivity • 10 unit injections • Use a higher dose: 300 units • Patients already self-catheterising

  26. Painful Bladder Syndrome • Two studies • one effective • one ineffective • Tried two patients with mixed effect • Raises questions as to how Botulinum toxin works

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