Botulinum toxin

Botulinum toxin is widely known by one of its trade names, Botox. It is a strong toxic substance which is used in
cosmetic surgery.

  • For overactive bladder (OAB) symptoms, botulinum toxin is injected into the bladder wall to reduce the nerve activity that causes the symptoms. This treatment may improve urgency, frequency of urinating, and urgency incontinence.
  • For benign prostatic enlargement (BPE), botulinum toxin blocks nerve endings and relaxes the smooth muscle in the prostate. This reduces the size of the prostate and improves the flow of urine.

The effect of the toxin will wear off after 4–9 months. As symptoms return, you will need to have another treatment.

Botulinum toxin injection

For botulinum toxin injections, you will usually be given numbing medication(local anaesthesia) in the area where treatment will be given. Sometimes other forms of anaesthesia are used.

  • For OAB treatment, the doctor inserts a tube-like surgical tool, known as a cystoscope, through the urethra. The cystoscope has a small camera to show a high-quality image of your bladder on a video monitor. The doctor injects a small dose of botulinum toxin into different areas of your bladder wall (Fig. 1).
  • For BPE, botulinum toxin can be injected into the prostate tissue through the urethra, the rectum, or the perineum (the tissue between the scrotum and the anus).

Some people (less than 10%) may have problems urinating after a botulinum toxin injection. If this happens, you may need a catheter. You will be shown how to insert the catheter yourself and must use it 5 times a day until the effect of Botox wears off. Catheters may increase the risk of urinary tract infection, so your doctor may prescribe antibiotics.

Fig. 1: Botulinum toxin is injected into the bladder wall.
Fig. 1: Botulinum toxin is injected into the bladder wall.