Botox may cut detrusor overactivity incontinence.(Gynecology)

ATLANTA -- Botox may be the answer for women with detrusor overactivity incontinence who have failed to respond to conservative therapy.

A cystoscopic technique that uses intradetrusor injections of botulinum toxin A injections to decrease bladder muscle overactivity associated with this type of incontinence was demonstrated in a video presented by Sangeeta Mahajan, M.D., at the annual meeting of the American Urogynecologic Society.

The in-office procedure, performed under local anesthesia, is proving safe and effective for women with resistant incontinence--both those with neurogenic bladders and those with neurologically normal bladders--said Dr. Mahajan of MacDonald Women's Hospital, Cleveland, Ohio.

She and her colleagues use a flexible or rigid cystoscope and the Wolf collagen-injection system with disposable needles, although comparable systems can be used. A total of 30 cc of 1% lidocaine is instilled into the bladder for anesthesia.

An additional 10 cc of 2% lidocaine can be placed in the urethra for more anesthesia. The lidocaine is left in place for 10 minutes to allow adequate anesthesia, but it does not have to be removed before injecting the toxin.

The Botox (Allergan, Inc.) is prepared using injectable saline and methylene blue to allow visualization of injection sites, and is placed into two 3-cc syringes for a total of 200 units in 6 cc of saline.

Cystoscopy is performed in a routine fashion with adequate bladder distention to visualize the urothelium. An initial Botox injection is completed at the midline of the bladder, just above the trigone, and the scope is carefully moved laterally left or right to allow additional injections at 4- to 5-cm intervals until four or five have been completed. Mirror-image injections are then performed on the opposite side, followed by a second row of injections 1 cm above the first row, for a total of about 20 injections.