Botox Approved as Second-Line Therapy for Overactive Bladder

Under direct visualization, Botox is injected evenly across the detrusor walls. (Image courtesy of Allergan)

At a Glance

  • Studies suggest Botox may now be considered a second-line therapy for the treatment of overactive bladder syndrome (OAB).
  • Specialists at UVA Women’s Center for Continence and Pelvic Surgery have been successfully performing this procedure for the past year.
  • The procedure takes about 10 minutes and is effective for urge incontinence with minimal complications and side effects.

As many as 40 percent of women in the U.S. live with the symptoms of overactive bladder (OAB), according to the Urology Care Foundation. However, that estimate only includes those who report their symptoms — the true count is likely much higher.

One patient, frustrated by the unrelenting symptoms of OAB, turned to UVA Women’s Center for Continence and Pelvic Surgery for relief. At age 42, she had been struggling with overactive bladder and urge incontinence for more than two years. She felt the need to urinate approximately 20 times a day and 5-6 times during the night. She also experienced leakage associated with urinary urgency 6-7 times a day.

When behavioral modifications and anticholinergic medications (oxybutyinin, tolterodine and solifenacin) failed to help, urogynecologist, Elisa Trowbridge, MD, division director for the UVA Women’s Center for Continence and Pelvic Surgery, suggested something different: Botox®.

Recent studies suggest that Botox injections into the bladder — once considered a third-line therapy for OAB — are safe and effective enough that the treatment should be considered soon after an initial medication therapy has failed. The American Urogynecologic Society (AUGS) and the American Congress of Obstetricians and Gynecologists (ACOG) have recommended that Botox injections may be an appropriate second-line therapy option.

Trowbridge’s patient underwent the procedure in March. A month later, she reported that her symptoms had abated. Her bathroom visits were reduced to three times a day and once a night, with no urine leakage. “I finally feel normal,” she says.

Who’s Eligible
“There are two types of patients that this therapy greatly benefits,” says Trowbridge. “People who have failed multiple medications for OAB and those who have urinary urgency and frequency (>10 voids/day), as well as urinary leakage associated with urgency,” says Trowbridge. “These are women who have to go to the bathroom all the time, day and night, and nothing works for them.”

For patients like these, she says, Botox has been “a game changer.”

Patients who are not good candidates for Botox treatment are those with chronic urinary tract infections and those who have trouble with incomplete emptying of the bladder.

How it Works
The Botox procedure is performed in an ambulatory surgical center under mild sedation.

It takes about ten minutes to complete. Doctors perform a cystoscopy, partially fill the bladder with saline, and then administer about 15 injections into the dome of the bladder. The bladder is then emptied and the procedure is over. Patients need to empty their bladders before they go home, and take antibiotics for the next three days.

In studies, 18 percent of patients developed a UTI after the procedure, which is why antibiotics are recommended. In about 6 percent of cases, patients initially have trouble emptying their bladders completely and will need to use a catheter for 7- 10 days after the procedure.

Botox loses its effect after about six months, but the procedure can be repeated twice a year as necessary. Medicare and other major insurers cover Botox as a treatment for overactive bladder if medication has been ineffective.

An Effective Alternative
Trowbridge says the average patient has had OAB for seven years and has tried four or five medications before they seek out a specialist like her. Doctors don’t need to wait that long, she says. She suggests that if a first medication fails, doctors should inform their patients about Botox.

“Unfortunately, the medications for overactive bladder only work in half of patients and they have numerous side effects, including dry mouth, constipation and dry eyes,” she says. “None of them are life-threatening, but they’re bothersome.” Moreover, she says, all of the current medications for OAB are similar in effectiveness, and quite costly.

Trowbridge adds that, compared to other options, results from the Botox treatment are impressive. “In 10 minutes, around a third of patients are completely cured,” she says. Sixty percent have a 50 percent reduction in the number of accidents they have. And again, you’re doing all this with next to no complications or side effects.”

“It’s a great option for patients who have suffered for so long,” she says.

UVA has a dedicated women’s health center for continence and pelvic surgery, with physicians and a nurse practitioner who have extensive experience and expertise in treating incontinence issues with a focus on patient-centered care. To refer a patient to the UVA Women’s Center for Continence and Pelvic Surgery, call 844.XFERUVA (844.933.7882).