Urge Incontinence and Botox Redux

Pete Health Guide
  • As many of you who have read my SharePosts know, I have access to intravesical Botox (which is "fancy" way of saying Botox injections into my bladder!) for my urge incontinence (UI). My UI developed as a side effect of a TURP to remove some infected tissue that was thought to be contributing to chronic UTIs.


    I was hoping that my doctor would inject the anterior wall of my bladder. In addition to temporarily correcting my urge incontinence, I was hoping that it would help with pain I have when voiding.


    The procedure this time was much the same as in the past. Although this procedure can be performed as office procedure, my doctor is reluctant to do so because she has to use a rigid cystoscope. This can be very painful for a male and so she feels that a higher level of pain control is required. Most of her patients have general anesthesia, but I prefer spinal anesthesia with no sedation. One nurse described me as the "ultimate control freak!"

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    A "real" anesthesiologist performed my spinal this time. In this past a CRNA (Certified Registered Nurse Anesthetist), under the watchful eye of an anesthesiologist, would usually "train" on me, which I really don't mind. (I have these procedures done at a teaching hospital.) This time it was the anesthesiologist who needed some training!


    While I may be a difficult cath, I don't believe I have, in the past, been a difficult stick. This time he had a very difficult time getting the needle into the proper location! I was sweating literally like a "stuck" pig! After the fourth or fifth attempt (at least TWO sticks for each attempt!) he asked the CRNA that was trying to keep me from jumping off the table to help him. He should have done this much sooner, as the CRNA must have got with only one or two more sticks! Finally!


    Once the anesthesia is administered the OR staff puts me into position for the procedure and washes my "diaper" area to sterilize it. This is actually the worst part of the procedure for me because I'm lying completely exposed with someone scrubbing my groin, something I usually do for myself. Fortunately this doesn't take long, and very quickly I'm draped appropriately and the OR lights are turned out.


    An uncommon side effect of spinal anesthesia is shivering, as if I'm very cold. I shook the entire procedure! I have shivered in the past, but not as long as I did this time. Presumably it was due to so many needle sticks. It's not dangerous, but can be very uncomfortable. Fortunately it did not appear to affect the procedure, because my doctor or the OR staff remained unconcerned.


    The rigid cystoscope has a miniature camera in it and is connected to a monitor. This is what the doctor views while performing the procedure. Usually the monitor is near my head and I can see it, but this time the OR staff put a sheet up in front my face so I "wouldn't get splashed" and I could not see anything! I like to watch because this is about my body and it gives me something to do. This time I had nothing to do but lie there and think about my aching back!


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    The doctor made (I believe) twenty injections, about one Botox unit each, into the back wall of my bladder. She does not have to remove the scope to do this. The doctor passes a small catheter with a needle on the end through the scope. The other end of the catheter, which is outside the scope, is connected to a small syringe containing the Botox. She positions the scope to the next location to be injected, pushes the scope close to the bladder wall, and pushes on the catheter so the needle punctures my bladder wall. An assistant pushes the plunger on the syringe to inject the Botox. She repeats this procedure until she completes all injections.


    With the spinal anesthesia, while I feel some pressure, I don't feel the actually injection. My doctor has to distend my bladder with saline so she can see to perform the procedure. While the procedure is not painful, there is some discomfort during the distention. Fortunately she is very sensitive to this and will occasionally drain some fluid out to make me more comfortable.


    I respond so well the Botox that I usually have to go home with a Foley catheter.  Because I'm difficult to catheterize (my doctor once tried 45 minutes and was not successful!) she usually uses the scope and guide wire to put the catheter in place. Once this was done, and I was cleaned up I was taken to the recovery room.


    I usually spend a two to three hours in recovery. I have to show that I can wiggle my feet, lift my knees, and be able to lift my bottom of the bed before they will take me to step-down recovery. Once again, nothing to do but wait! I got lucky this time, because I was the only patient my nurse to attend to. She was more than willing to bring me coffee, something to eat and something to read, and to chat with me. All of this really helped me to pass the time.


    Once I'm able to do all of the "tests" above I am moved to step down recovery, where they keep me until they are sure I can at least stand without falling!


    Foley stayed with me for two weeks. At my follow-up the nurse practitioner drained my bladder, filled me up with about 500 milliliters of saline, pulled Foley and had me see how much I could void. While I'm always glad to see Foley go, I hate having him removed because the little balloon never deflates completely! This makes the removal very uncomfortable.


    As in the past I was unable to void much. What I did void was due to bladder spasms triggered by the removal of Foley. Fortunately (should I say unfortunately) I am able to catheterize myself, and so will be doing that for some weeks yet.


    Although this is difficult and some painful, it is a small price to pay for 5 or 6 months of being dry!


Published On: February 08, 2009