Botulinum Toxin A is a purified protein produced by the bacterium Clostridium Botulinum.

Most of the people know that Botulinum Toxin A (acknowledged with the commercial names Botox or Dysport) is used for cosmetic reasons, mainly from people who can afford it.

This preparation is also used for more infrequent neurological diseases such as dystonias, hyperhidrosis, torticollis, muscle spasms after stroke etc.

 The many however do not know that the clinical application of Botulinum Toxin A, brought revolution in the treatment of a wide spectrum of urogenital diseases.

 In the Chronic Pelvic Pain Syndrome the contribution of Botulinum Toxin A has important implications on its treatment options.

In patients with neurogenic bladder the use of intradetrusor injections (injections directly in the bladder wall) of Botulinum Toxin A, help to dramatically reduce or terminate the incontinence episodes.

It can also be helpful in selected cases of Interstitial cystitis , Chronic prostatitis, and pelvic floor muscle spasms.

Botulinum Toxin A toxin is a specifically processed toxin of microbe Clostridium Botulinum.

 Its main action is to induce a medically controlled paralysis of the target group of muscles. The toxin is relatively harmless for the remainder organism because it has mainly local action.

 But how a patient with problems from the urogenital system can know if the use of Botulinum Toxin A can benefit him?

In every patient with inexplicable dysfunction of urinary system, a full urodynamic examination should be performed first, in order to diagnose and classify the type and extend of the disease. This knowledge would be of great help to decide whether a specific patient could cured or at least improved by the Botulinum Toxin A treatment.

There should be also failure or non applicability of more conservative treatments for example with drugs, behavioural modification, or physiotherapy.

The Botulinum Toxin A can be administered without anaesthesia (depending of course from the neurological status of the patient), it is always however performed in the operating theatre in order to avoid infections or other complications. When a type of anaesthesia is required it can be done with sedation or a spinal anaesthesia will suffice. The urologist with a special interest in treating neurogenic bladder disorders is the specialist that can safely administer Botulinum Toxin A.

Procedure: after a careful cystourethroscopy and urinary bladder mapping, we use the operating cystoscope and a special designed needle to inject medicine in specifically selected regions of wall of urinary bladder. The duration if the process is about 20 minutes, and the patient’s recovery is uneventful. 

Watch a video from one of our cases >>>

But what about the side effects?

There is no treatment in this world without any possible side effects. Thankfully in Botulinum Toxin A the side effects are minor if any.The side effects are infrequent because, as we mentioned, the injections are local in the wall of urinary bladder, with negligible systematic absorption.

The most frequent side effect is transient paralysis of urinary bladder lasting days to weeks, which is reversible and can be managed by intermittent self catheterization until the return to normal function.

It is imperative for the patient has to be well informed for this possibility.

This however is not problem for most patients with neurogenic bladder because the vast majority of them are already familiarized with this issue.

The patient also need to know that he or she will have to wait for a period up to two weeks in order to see the results, and that the duration of action of  Botulinum Toxin A lasts approximately  6 to 9 months.

After this time interval it is possible to repeat the injections.

We should mention here, that method is not experimental, but already exists large experience in Europe and in the USA with hopeful results so far.

In conclusion the use of  Botulinum Toxin A with injections directly in the urinary bladder wall is  a good alternative solution in the  treatment of patients with neurogenic bladder  of any cause, but also in other chronic diseases of urogenital system, such as some of the causes of chronic pelvic pain syndrome.