Botox for Urge Incontinence: How It's Done

Pete Health Guide August 25, 2008
  • I've written many SharePosts about the efficacy of Botox for urge incontinence. In reviewing my posts, I realized I've never provided information about the procedure itself.

     

    Most procedures use about 200 to 300 units of Botox injected about 10 units at a time. This means about 20 to 30 injections into your bladder. The amount in a unit depends on the manufacturer.

     

    There are a couple of methods used for this procedure, and the choice usually depends on the doctor or clinic performing the procedure. The procedure is almost always performed in the doctor's office or as an outpatient procedure. Unless there are complications, a hospital stay isn't required.

     

    If the procedure is done in the doctor's office, local anesthesia is used (with or without some sedation). In this case, a lidocaine solution is instilled in the bladder and left for 15 minutes or so. If the procedure is done in a hospital or operating room, there's usually the choice of either general or spinal anesthesia.

     

    The procedure is done during a cystoscopy. There are two types of cystoscopes: rigid and flexible. If a rigid scope is used, either general or spinal anesthesia will generally be used, as local anesthesia would not be enough. If a flexible scope is used, local anesthesia is usually sufficient.

     

    The doctor passes a small flexible tube with a needle at the end (cystoscopic needle) through the scope and into the bladder. A syringe containing the Botox is connected to the tube. The scope is positioned at the location to be injected and the tube is pushed such that the needle is pushed into the bladder wall. The doctor then injects a small amount of Botox into the bladder. The needle is then pulled out of the bladder wall, the scope is repositioned, and the injection repeated as needed. Note that the cystoscope is not removed from the bladder during the procedure.

     

    My doctor isn't comfortable doing this as an office procedure, so my procedure is usually done in an operating room. I ask for spinal anesthesia so I remain awake. My doctor used a rigid cystoscope with a needle probe passed through the scope. It's not painful and I don't feel the injections, however, the hydrodistention (expansion with water) the doctor must do to see the bladder can be moderately uncomfortable. My doctor positions the scope using the video monitor. If you're brave and the monitor is positioned correctly, you can even watch!


    The 20 to 30 injections are usually done in a grid on the back wall of the bladder. My doctor does 20 injections regardless of the amount of Botox used, and the grid is 4 columns by 5 rows. Because of the way the scope works, only the back wall up to the bladder dome can be injected. My doctor stays above my ureters and trigone to avoid damaging or paralyzing the valves that control the backflow of urine during voiding.

     

    Once the procedure is complete and if local anesthesia was used, you can usually get dressed immediately and go home shortly after. If the procedure is done in the operating room, like with any other surgical procedure you will spend time in recovery. Because I have spinal anesthesia for my procedures, my stay in the recovery room is usually longer than if I had general anesthesia because I have to be able to move my legs and lift my bottom before being released.

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    Needless to say, an office procedure is much less expensive than a "surgical" procedure. I've talked to my doctor about doing this in her office, but she feels it's better for both of us to use the operating room. Several clinical studies have been done to determine the efficacy of Botox for urge incontinence, and many procedures are performed in a doctor's office to save cost.

     

    Hopefully this has provided you with a good look at how Botox is used as a treatment for urge incontinence.