[Essbee]

As a result of my urodynamics test, I have been offered botox injections, which I'm told have an 80% success rate. I have to learn how to use a catheter because it is possible the botox will prevent me from urinating normally. Has anyone had this treatment? Does the need to use a catheter wear off before the botox stops working? Can anyone recommend such an unpleasant sounding procedure? Are there any other risks to consider? I can't find any statistics to help me judge what is best.
Essbee

[UroDoc]

You could also consider Interstim, good luck.

[macsmaker]

I had botox about three months ago for UI that was the result of a TURP. It basically has cured my UI, at least for the time being. I tried all oral medications for UI/OAB and nothing worked. The procedure itself was not to bad. The biggest problem I had was a foley for three weeks, which was probably unecessary. Other than that, I'm glad I had it done. Consistently dry britches for the first time in 18 months!

Most procedures use about 300 units of Botox, injected about 10 units at a time. This means about 30 injections into your bladder. (In my case it 20.) Needless to say, without medication, this could be painful.

My procedure was done in an operating room. I had my choice of either general ("put to sleep") or spinal. I had spinal, so I was awake. It was not painful. I did not feel the injections. However, the hydrodistention they must do to see the bladder was moderately uncomfortable.
My doctor used a rigid cystoscope with a needle probe passed through the scope. A syringe containing the Botox was attached to the probe on the outside of the scope. She would press the needle into my bladder wall and inject a small amount of Botox.
Does this help?

[Essbee]

Thanks for your reply. It doesn't sound particularly pleasant, but there again, not too awful, either. The details you gave are really helpful - fear of the unknown is usually worse than the facts!

[macsmaker]

One thing I did fail to mention, I did have to self-cath for about a week after the foley was removed. Most people do NOT have to have a foley. From the research that I have done, most people do not have to self-cath very long after the botox. Let me state again I am very happy with results. If my UI comes back (botox generally lasts 6-9 months) and I can, I will have it done again.

[Essbee]

Sorry to be ignorant, but what is a foley? Also, I've been told the botox will be done under a local anaesthetic - is this the injection into the spine, or is there another way?

[macsmaker]

Foley catheter. It has a little balloon that is inflated once the catheter is inserted into your bladder. It keeps the catheter from slipping out. The urine drains from the catheter into either a night bag or a small bag strapped to your leg. (I know, it's gross.) I doubt you will need one, but it is a question for your doctor.
The only local anesthetic I know about is a lidocaine solution put into your bladder for about 15 minutes prior to the procedure. I know that Vanderbilt University has participated in a botox study for OAB and this is the way they do it. I talked to one of the nurses involved in this study and she said the patients don't feel much, if anything. I also know many doctors are doing it this way now. If I have the need, and get the opportunity to do this again, I'm going to ask about doing it this way. This was the first time my doctor had done this, so she was not comfortable with a local. Local is always preferrable, as long as the pain is controlled. Both spinal and general anesthesia can be risky. Once again, I would ask your doctor. Also ask if they intend to use a rigid or flexible scope. A flexible scope is more comfortable, but not sure this matters too much for women. It certainly does for men, with our anatomy. Does this help?