USE OF BOTOX IN BLADDER DISORDERS AN INFORMATION LEAFLET Written by: Department of Urology January 2017 Stockport: 0161 419 5698 Web site: w w w. s t o c k p o r t. n h s. u k Tameside: 0161 922 6696/6698 Website: w w w. t a m e s i d e. n h s. u k Macclesfield: 01625 661517
What Is Therapy? The medication commonly called is a purified toxin made from a bacterium. As such this is a toxic product, but it has been used safely to control a variety of muscular disorders, including muscular spasms of the neck, shoulders and face as well as for foot deformities in children with cerebral palsy and also for excessive sweating. It is more widely known for its cosmetic use in reducing wrinkles. The first European approval for its medical use was granted in 1992. Injection of into the bladder is a minimally invasive procedure and you can usually be treated as a day case (going home the day of the operation) or with one overnight stay. It is usually done under general anaesthetic (when you are put completely to sleep) or may be done under local anaesthetic (medication inserted to numb the area to be treated). A cystoscope (an instrument used to see inside the bladder) is passed via the urethra (tube you pass urine through) and the is injected into several specific sites in the bladder. The beneficial effects are usually seen three to four days after the injection and normally last between six and nine months. If your symptoms have improved with you may be offered further injections when the effects have worn off. What Are The Benefits? has been successful in treating a variety of bladder and continence disorders including overactive bladder syndrome. You will have had urodynamic investigations (bladder pressure tests) to confirm that your bladder is overactive and already tried tablets and bladder training treatments. If these treatments have not worked or you have been unable to tolerate the side effects of the tablets, will be offered to you. The over-activity of the bladder muscles may cause symptoms of urgency (a sudden strong desire to pass urine) urge incontinence (leakage of urine following a sudden strong desire to pass urine) frequency (having to pass urine frequently) or bladder discomfort. produces a temporary paralysis of the injected muscles, improving and sometimes resolving the symptoms altogether. What Are The Alternatives? Oral medication Behavioural therapy, in the form of bladder training incorporating the use of pelvic floor exercises Instillation of drugs directly into the bladder via a catheter (tube inserted into the bladder via the urethra) Sacral or tibial nerve stimulation Surgery - cysto-distension (a procedure carried out to increase the amount of urine that the bladder can hold) clam-cystoplasy (a major operation which aims to increase the capacity of the bladder by sewing bowel tissue to the top part of the bladder) urinary diversion (a major operation which involves redirecting the flow of urine from the kidneys usually to a stoma on the outside of the abdomen) Are There Any Risks? The use of is very safe, but occasionally there can be side effects. These include;
A 20% risk of the working so well that you experience difficulty emptying your bladder completely, possibly requiring intermittent self-insertion of a catheter (tube inserted into the urethra to drain the urine from the bladder). You will be taught how to do this before the operation can take place and may need to do this until the effects of the wear off. Bleeding on passing urine for a short period of time after the procedure. Mild burning on passing urine. Urine infection which may require antibiotics. Headache, light-headedness. Abdominal pain and/or diarrhoea. Fever; very occasionally patients may experience flu-like symptoms during the first week and may need to be looked after as an in-patient in hospital. Generalised weakness due to the effect of the toxin on the muscles of the body, requiring admission to hospital Repeated injections may be needed if symptoms return. Possible failure to improve symptoms. Hospital-acquired infection Colonisation with MRSA (0.9% risk - 1 in 110) Clostridium difficile bowel infection (0.01% risk - 1 in 10,000) MRSA bloodstream infection (0.02% risk - 1 in 5000) The rates for hospital-acquired infection may be greater in high-risk patients e.g. with long-term drainage tubes, after removal of the bladder for cancer, after previous infections, after prolonged hospitalisation or after multiple admissions. Important Points As has only been used for the past four to five years to treat urological disorders, the effects of its long-term use are not known. In research trials patients have been given up to 7 repeated injections. However has been used for the past twenty years in other situations such as muscle injections, where no long-term side effects have been reported. Some medications may stop working and so it is important that you let us know what tablets you are taking. Common ones that affect in this way are; Nifedipine Amlodipine Verapamil Diltiazem It is important to let us know if any of the following conditions apply to you, as it is not safe to have if;
you are pregnant you are allergic to albumin (egg allergy) you have any of the following Myasthenia Gravis Eaton Lambert syndrome Amyotrophic lateral sclerosis On the Day of the Procedure You will have nothing to eat or drink for several hours before the operation. If you would normally take tablets during this time, please ask at the pre-operative assessment clinic which you should continue to take. Before going to the operating theatre, you will be asked to change into a theatre gown. Any make-up, nail varnish, jewellery (except your wedding ring), dentures and contact lenses must be removed. What Happens On Arrival At The Ward? Your operation will be at Stepping Hill Hospital, Stockport. Routine clinical observations will be taken, possibly including blood tests, blood pressure, pulse and temperature. You should not have anything to eat or drink for about six hours before the operation. The anaesthetist will visit you on the ward to discuss the anaesthetic and the risks involved. What Happens After The Procedure? The nurses looking after you will monitor you closely when you return to the ward, and will take observations such as pulse and blood pressure. If you experience any pain or discomfort, please request pain-killers from the nursing staff You will be able to eat and drink as soon as you feel up to it. You will be encouraged to move around the ward as soon as possible, to prevent complications such as deep vein thrombosis (blood clot in the leg). Discharge Arrangements You should arrange for a responsible adult to collect you from hospital and transport you home. It is important that in the first twenty four hours of having a general anaesthetic you should avoid: Being left in the house alone, or looking after young children Driving (it is advisable to check with your insurance company as to how long your insurance is invalid following general anaesthetic. Operating machinery: this includes cookers and other domestic appliances. Making any important decisions or signing any legal document. Drinking alcohol.
Any follow-up appointment will be made at your local urology department and sent to you via the post. If you are to perform self-catheterisation, you will be given a small supply of equipment and information on how to obtain further supplies via your GP or a delivery company. You may be referred to a Specialist Urology Nurse who will check on your progress/technique. Day To Day Living You can return to normal activities within a couple of days of the operation, or as soon as you feel well enough to do so. If There Is A Problem? If you experience any problems after discharge from hospital, please get in touch with your GP. Other Useful Contacts or Information If you have any questions you want to ask, you can use this space below to make notes to remind you. Source In compiling this information leaflet, a number of recognised professional bodies have been used, including the British Association of Urological Surgeons. Accredited good practice guidelines have been used. If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Health Information Centre on 0161 922 5332 If you would like any further information please telephone the Urology Nurse Specialists at your local Urology Department on: Stepping Hill 0161 419 5695 Tameside 0161 922 6696/6698 Macclesfield 01625 661517
Author: Division/Department: Date Created: Reference Number: Version: Urology Department Elective Services June 2009 Version 1.4