Botox for Incontinence

Prior to the botox procedure, it is important to ensure the patient does not have an active urinary tract infection. If the procedure is not being performed under IV sedation, the physician begins by inserting lidocaine jelly transurethrally. Physicians can utilize either a rigid cystoscopy with an injectable set up, or a flexible scope with a non-injection set up. The botox is reconstituted in sterile saline before it is injected into the detrusor muscle. A successful injection will leave a wheal under the bladder mucosa. Beginning at the midline, botox injections are made towards the right in 0.5 cm intervals until the bladder sidewall is reached. This is repeated, moving left of the midline. The next row of botox injections is 0.5-1 cm above the first row. Trainees may find it useful to add a small amount of indigo carmine to the botox, making it easier to note previous injection sites. Potential adverse effects of the botox procedure include dysphagia, blurred vision, and generalized weakness.