Background:The awareness of the overactive bladder (OAB) has become ever increasing for the patient as well as the physician. There are many good first line oral medications available. However, large numbers of patients either cannot tolerate these medications or have limited relief from them. These patients continue to be a therapeutic challenge to the medical community. Botulinum toxin A (BOTOX) is commercially approved for the use of muscle spasms in many diverse settings. This report shows its use in treating overactive bladder in a community setting.
Methods: This is a retrospective review of 57 women ages 44 to 78 (mean=60 ) who underwent an endoscopic injection of Botox from 8/2002 to 3/2005,. All women underwent preoperative urodynamics testing and completed voiding diaries. All the patients reported urge incontinence preoperatively. The follow up ranged from 2 months to 2.5 years (mean 14 months). Patients were seen at 2 weeks post injection and then monthly. On follow up, a post void residual (PVR), subjective assessment via a questionnaire,and voiding diary were obtained. All the patients had 300 units of Botox injected circumferentially around the bladder using an endoscopic needle. 10 units of Botox were injected in 30 sites with the trigone being avoided. The injections were carried out in the detrusor muscle.
Results: 5 of the patients had a neurologic condition that was related to their OAB while the remaining patients did not. 48/57 reported a greater than 50% improvement in urgency and urge incontinence and were happy with there results. 51/57 reported a greater than 50% reduction in frequency of urination. The effect of the Botox lasted form 3 months to 15 months with a mean response of 7 months. 5 of the patients injected have thus far requested repeat injections. Two patients went into urinary retention and required catherization for 2 weeks. One patient was noted to have a PVR of 250 mls which was treated with observation. There were no reports of significant pain or muscle weakness. All patients were treated as outpatients.
Conclusions: Botox appears to be safe and effective for the treatment of OAB that is refractory to medications or in patients with intolerance to OAB medications.

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