Urge incontinence is not a sling, but botulinum toxin
It is important to distinguish between two types of incontinence: stress (during coughing, exertion) is treated with sling surgery, and urgency - sudden uncontrollable urges - is associated with hyperactivity of the bladder muscle and is treated with drugs, bladder training and botulinum therapy. The diagnosis is confirmed by a urination diary and, if necessary, urodynamics. Botulinum toxin is injected into 20–30 points of the detrusor, bypassing the area of the triangle and orifices; the dose is selected according to indications (100–200 units for idiopathic, 200–300 units for neurogenic hyperactivity). The procedure is repeated as symptoms return.
Who does botulinum therapy help?
- overactive bladder with urge incontinence, unresponsive to medications (M-anticholinergics, beta-3 agonists) or intolerant to them;
- neurogenic detrusor hyperactivity in multiple sclerosis, spinal cord injury, myelodysplasia;
- frequent urination and night urges, which reduce the quality of life;
- interstitial cystitis as part of complex treatment.
How it goes and what to expect
After an anesthetic gel (or under sedation) through a cystoscope, the drug is injected into 20-30 points of the bladder wall - the procedure takes 15-25 minutes, you can go home after an hour. The effect develops over 1–2 weeks: uncontrollable urges disappear, bladder capacity increases, and the frequency of urination decreases. The effect lasts 6–9 months, then the injections are repeated. The cost of the drug according to the price list is paid separately.
Possible side effects
In 5-10% of patients, temporary difficulty emptying the bladder with an increase in residual urine occurs - periodic self-catheterization, which is taught before the procedure, may be required for several weeks. The risk of infection is reduced by antibiotic prophylaxis. Allergic reactions are extremely rare. The procedure is not performed in case of active infection, pregnancy or myasthenia gravis.
