Page 1 of 4 1234 LastLast
Results 1 to 10 of 31

Thread: Botox for the bladder - How to get it done?

  1. #1
    Senior Member Jeff's Avatar
    Join Date
    Jul 2001
    Location
    Argao, Cebu, Philippines
    Posts
    6,864

    Botox for the bladder - How to get it done?

    I'm convinced that botox, followed by anticholinergics if necessary, is my best bet.

    The only way I could find a doctor is by contacting U Pitt where they did the study. They have a doctor doing the procedure for the public. It's a six hour drive but would be well worth it to me. OTOH, is there any way to find a doc any closer?

    The people at UPMC say insurance is not covering the procedure. Is there any way to get them to pay or should I just not even try?

    And how about getting O'Neill catheters covered? They cost about five bucks a piece. I know some of you guys have those covered. Just use a regular LMN from my urologist, I guess.

    Well....I'm going for it. Please give me any advice you can. Hopefully, by the time my next treatment is required my insurance will cover it!

    ~See you at the SCIWire-used-to-be-paralyzed Reunion ~

  2. #2
    My Urologist is performing this procedure at the Lahey Clinic in Burlington, MA. He was part of a team of Doctors who initially did a study at the Cleveland Hospital. He seems to have gotten Insurance to pay in some cases, but not all. He's performed this on 4 patients so far, and has approached me to consider it. In a nutshell he says he injects the inside of your bladder, at about 30 different points, with Botox. It slowly allows the bladder to expand, by relaxing the muscles, over the course of 4-6 months. Then a second similar procedure is done, lasts up to 2 years before you need another booster. He has followed this procedure done in Europe for some time now and feels it will quickly become accepted in the US.

    "Problems cannot be solved at the same level of awareness that created
    them."

  3. #3
    I see you're in NJ. I know Dr. Linsenmeyer at Kessler in West Orange was doing them at one time, he could be closer for you and he's a good doc. It's not just a one time treatment. re-injection is required 2-3x/yr and there is a unlimited lifetime use is not possible. Dr. L can poss give u info regarding insur reimb.

  4. #4
    I'm confused does your bladder have wrinkles?

    What exactly does this procedure do?

    -Lewis

  5. #5
    I would second checking with Dr. Linsenmeyer. Even if he does not do the Botox injections, he is very likely to know who else in your area does that has the appropriate experience and training.

    Botox works by killing the butons (the end plates of the nerves where they attach to the muscle). Botox injections to the bladder are done essentially to try to convert a spastic or reflex bladder into one that is flaccid or areflexic. Of course this means that you must catheterize since your bladder would no longer empty on its own (as with those who use an external catheter).

    Eventually (usually) the butons grown back, which is why the procedure must be repeated periodically. It is also a concern since there is currently a life-time maximum dosage allowed for Botox for any one person by the FDA.

    Since the procedure is new, many insurance companies will want to consider it experimental, or will not have it listed in their code books as a covered procedure. They may have Botox injections only listed as a cosmetic surgery procedure.

    If you are turned down, you need to file an appeal. The appeal should be written by the physician who is doing the procedure, and should be accompanied by 1-2 good research or journal articles about the utility of this procedure in people with neurogenic bladders.

    (KLD)

  6. #6
    Dr. Linsenmeyer is doing Botox injections; he's talked with Matt about it. And I'm sure he could write a pretty decent justification to the insurance company!

    _____________
    Tough times don't last - tough people do.

  7. #7
    Jeff, I am just coming in on the tail end of this discussion and do not understand the reason for doing botox injections into the bladder. Are you considering it for bladder spasticity? Are you thinking of stopping or reducing ditropan? Are you thinking of doing it so that you don't have to catheterize? By the way, here are some abstracts of papers on the subject. Wise.


    • de Seze M, Petit H, Gallien P, de Seze MP, Joseph PA, Mazaux JM and Barat M (2002). Botulinum a toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur Urol 42:56-62. Summary: OBJECTIVE: To compare the efficacy and tolerance of botulinum A toxin (BTx) versus lidocaine (L), applied in the external urethral sphincter with a single transperineal injection in order to treat detrusor sphincter dyssynergia (DSD) in spinal cord injured patients. METHODS: Thirteen patients (1F, 12 M) suffering from chronic urinary retention due to DSD were randomised to receive one transperineal injection of 100 IU BTx Botox degrees in 4 ml of 9% saline (botulinum group, (BG)) or 4 ml of 0.5% L (lidocaine group, (LG)). The main criteria of efficacy was post-voiding residual urine volume (PRUV), assessed three times daily on day one (D1), D7 and D30 after each injection. Other criteria were micturition diary, satisfaction score (SS), maximal urethral pressure (MUP), maximum detrusor pressure (DP) and type of DSD, recorded on D0 and D30. RESULTS: In the BG, there was a significant decrease in PRUV (D7: -141.4 ml (p<0.03); D30: -159.4 ml [p<0.01)), in MUP [D30: -32 cm H[2)O, p<0.04) whereas no significant improvement was shown in the LG. SS was higher in BG than LG [p<0.02). DSD improved in BG whereas it remained unchanged in LG. All LG patients also received one injection of BTx on D30. They still presented improvement in PRUV and MUP 1 month later [D30'). Tolerance appeared satisfactory in both groups. CONCLUSIONS: The preliminary results of this initial randomised double-blind study clearly demonstrated the superiority of BTx compared to L in improving clinical symptoms and urethral hypertonia associated with DSD in spinal cord injured patients. Service de Medecine Physique et Readaptation, Centre Hospitalier Universitaire de Bordeaux, Hopital Pellegrin Tastet-Girard, Bordeaux, France. madeseze@club-internet.fr

    • Phelan MW, Franks M, Somogyi GT, Yokoyama T, Fraser MO, Lavelle JP, Yoshimura N and Chancellor MB (2001). Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol 165:1107-10. Summary: PURPOSE: Botulinum toxin injection into the external urinary sphincter in spinal cord injured men with detrusor-sphincter dyssynergia has been reported. We expand the clinical use of botulinum toxin for a variety of bladder outlet obstructions and to decrease outlet resistance in patients with acontractile detrusor but who wish to void by the Valsalva maneuver. MATERIALS AND METHODS: Prospective treatment was performed for voiding dysfunction in 8 men and 13 women 34 to 74 years old. The reasons for voiding dysfunction included neurogenic detrusor-sphincter dyssynergia in 12 cases, pelvic floor spasticity in 8 and acontractile detrusor in 1 patient with multiple sclerosis who wished to void by the Valsalva maneuver. Using a rigid cystoscope and a collagen injection needle, a total of 80 to 100 units of botulinum A toxin (Botox) were injected into the external sphincter at the 3, 6, 9 and 12 o'clock positions. RESULTS: Preoperatively 19 of 21 patients were on indwelling or intermittent catheterization. After botulinum A injection all but 1 patient were able to void without catheterization. No acute complications, such as general paralysis or respiratory depression, occurred and none of the patients had dribbling or stress urinary incontinence. Postoperative post-void residual decreased by 71% and voiding pressures decreased on average 38%. Of the 21 patients 14 (67%) reported significant subjective improvement in voiding. Followup ranges from 3 to 16 months, with a maximum of 3 botulinum A injections in some patients. CONCLUSIONS: Urethral sphincter botulinum injection should be considered for complex voiding dysfunction. Encouraging improvement without complications were seen in most of our patients. We have expanded the use of botulinum toxin to treat pelvic floor spasticity and also women. Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

    • Schulte-Baukloh H, Knispel HH and Michael T (2002). Botulinum-A toxin in the treatment of neurogenic bladder in children. Pediatrics 110:420-1. Summary:

    • Schurch B, Stohrer M, Kramer G, Schmid DM, Gaul G and Hauri D (2000). Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 164:692-7. Summary: PURPOSE: We evaluated the efficacy of botulinum-A toxin injections into the detrusor muscle in patients with spinal cord injury, detrusor hyperreflexia and urge incontinence resistant to anticholinergic drugs. The purpose of treatment was to suppress incontinence episodes and increase functional bladder capacity. MATERIALS AND METHODS: Included in our prospective nonrandomized study done at 2 clinics were 31 patients with traumatic spinal cord injury who emptied the bladder by intermittent self-catheterization. These patients had severe detrusor hyperreflexia and incontinence despite a high dose of anticholinergic medication. Pretreatment evaluation included a clinical examination and complete urodynamic investigation. Under cystoscopic control a total of 200 to 300 units of botulinum-A toxin were injected into the detrusor muscle at 20 to 30 sites (10 units per ml. per site), sparing the trigone. Clinical and urodynamic followup was planned for 6, 16 and 36 weeks after treatment. Patients were asked to decrease their intake of anticholinergic drugs during week 1 after treatment. RESULTS: Of the 21 patients 19 underwent a complete examination 6 weeks after the botulinum-A toxin injections, and 11 at 16 and 36 weeks. At the 6-week followup complete continence was restored in 17 of 19 cases in which anticholinergic medication was markedly decreased or withdrawn. Less satisfactory results in 2 cases were associated with an insufficient dose of 200 units botulinum-A toxin. After the injections overall mean reflex volume and mean maximum cystometric bladder capacity plus or minus standard deviation significantly increased from 215.8 +/- 90.4 ml. to 415.7 +/- 211.1 (p <0.016) and 296.3 +/- 145.2 to 480.5 +/- 134.1 [p <0.016), respectively. There was also a significant decrease after treatment in mean maximum detrusor voiding pressure from 65.6 +/- 29.2 cm. water to 35 +/- 32. 1 [p <0.016). Mean post-void residual urine volume catheterized at the end of the urodynamic examination increased significantly from a mean of 261.8 +/- 241.3 ml. to 490.5 +/- 204.8 [p <0.016). Moreover, autonomic dysreflexia associated with bladder emptying that manifested as a hypertensive crisis during voiding disappeared after treatment in the 3 patients with tetraplegia. Satisfaction was high in all successfully treated patients and no side effects were observed. Ongoing improvement in urodynamic parameters and incontinence was already present in all patients reevaluated at 16 and 36 weeks. CONCLUSIONS: Botulinum-A toxin injections into the detrusor seem to be a safe and valuable therapeutic option in spinal cord injured patients with incontinence resistant to anticholinergic medication who perform clean intermittent self-catheterization. Successfully treated patients become continent again and may withdraw from or markedly decrease anticholinergic drug intake. A dose of 300 units botulinum-A toxin seems to be needed to counteract an overactive detrusor. The duration of bladder paresis induced by the toxin is at least 9 months, when repeat injections are required. Swiss Paraplegic Centre, University Hospital Balgrist and Departments of Urology, University Hospital, Zurich, Switzerland.

  8. #8
    Senior Member Jeff's Avatar
    Join Date
    Jul 2001
    Location
    Argao, Cebu, Philippines
    Posts
    6,864
    Hi Wise. Ditropin never really worked for me. My bladder spasms would get a lot weaker but never go away. I think I need to switch from a spastic bladder to doing intermittent cathing in order to cut down on UTIs. So Botox has to be worth a try. Especially since I can still use ditropin in addition to having the procedure.

    I checked with Dr. Linsenmeyer's office. He only uses botox for relaxing sphincter muscles...not for the bladder itself.

    Lewis - I assume you understand now.

    BlkDiamond - Thanks for the info. I might inquire there, too. That's only a four hour drive for me.

    ~See you at the SCIWire-used-to-be-paralyzed Reunion ~

  9. #9
    If you have to take such measures to relax your bladder, why don't you just wear a condom? I assume that is what you're doing now so there must be a problem (UTI's). Maybe you should wear a condom as well as cath every 24-hour period to make sure your bladder is drained.

    -Lewis

  10. #10
    Senior Member Jeff's Avatar
    Join Date
    Jul 2001
    Location
    Argao, Cebu, Philippines
    Posts
    6,864
    Thanks, Lewis. I've actually been there and done that.

    There are other benefits to going this route.....one of which is majorly reducing bladder pressure. Bladder pressure alone can account for increased UTIs.....or so I've been told. And can cause kidney damage. At 23 years post SCI I'm willing to start cathing regularly if that means I'll be healthy longer. And a low pressure bladder? Bring it on.

    ~See you at the SCIWire-used-to-be-paralyzed Reunion ~

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •