Title:Intravesical Botox for Overactive Bladder: How to Minimize Complications and Manage Failures
Volume: 21
Issue: 15
Author(s): Apostolos Apostolidis*, Efstathios Papaefstathiou and Sotirios Gatsos
Affiliation:
- 2nd Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki,Greece
Keywords:
Botulinum toxin, onabotulinumtoxinA, botox, bladder, detrusor, neurogenic, idiopathic, overactive.
Abstract: Intravesical Botox has become a widespread treatment for patients with refractory overactive
bladder. Further to its acknowledged efficacy, both physicians and patients must be fully aware of
possible complications, such as urinary tract infections, incomplete bladder emptying or even urinary
retention and the possible need for intermittent self-catheterizations, fatigue, muscle weakness, transient
hematuria and autonomic dysreflexia. Careful patient selection, particularly in terms of comorbidities,
caution with technical aspects of the procedure such as the use of fine specifically designed injection
needles, treatment of baseline UTIs or bacteriuria and avoidance of bladder overfilling could be
the main measures, in addition to rigorous patient follow-up, to minimize the risk of post-Botox UTIs,
hematuria, autonomic dysreflexia, and retention. Management of Botox failures is currently an unchartered
area, starting with the definition of failure per se. Nevertheless, dose increase, particularly in
neurogenic patients, increase of treatment frequency, switch to abobotulinumtoxinA, prolongation of
injection intervals with add-on oral therapy, use of percutaneous tibial nerve stimulation or sacral neuromodulation
and alleviation of risk factors for failure such as UTIs may be part of the management
algorithm for Botox failures. As there is little evidence base to support such proposals and as the use
of intravesical Botox is increasingly becoming a part of common urological practice, further research
into the field of Botox failures and complications is needed so that both physicians and patients are
granted with more solid, viable options.
