Metro Urology

What is it?

Botox® was approved by the FDA in the 1980s to treat certain disorders of the eye muscles and is now widely used in cosmetic surgery to treat wrinkles. It has been used in urology since the late 1990’s to treat certain disorders of the bladder and urethra. It acts by binding to the nerve endings of muscles, blocking the release of the transmitter that causes the muscles to contract. The effect is to temporarily paralyze or weaken the muscles at the site of injection.

How is it done?

During a cystoscopy the Botox® is injected through the scope at several sites into the muscle of the bladder. This generally takes approximately 30 minutes  and can be done under local anesthesia in the office or general anesthesia in the hospital as an outpatient procedure.

What are the benefits?

Botox® can be used to treat incontinence or urgency/frequency caused by involuntary contractions of the bladder muscle. The benefits usually last for 6-9 months, and the procedure can be repeated, if successful. Studies have shown that roughly 2/3 of patients will benefit from this approach.

What are the risks?

Risks of cystoscopy include bleeding and infection, which are generally mild and treatable. The amount of Botox® needed to treat each individual bladder varies. If too little is injected, the symptoms may be partially treated, and a larger dose can be used at the next injection. If too much is injected, the bladder may not empty completely, requiring intermittent catheterization or an indwelling catheter.

What are the alternatives?

Biofeedback (pelvic muscle physical therapy) and anticholinergic medications such as oxybutynin (Ditropan) and tolterodine (Detrol) are used to treat urgency and urge incontinence. These options will usually have been tried without sufficient benefit before Botox® is considered. Neurostimulation of the sacral nerves (Interstim®) is another option for urgency/frequency and urge incontinence. Since that
therapy is testable, reversible, long lasting, and FDA approved for urinary problems, it is usually considered before Botox®. Botox® is a more attractive alternative than catheters, major bladder surgery (bladder enlargement procedures), or just living with the problem when simpler options don’t help.

Is it covered by my insurance?

Currently Botox® is not FDA approved for use in the bladder and as such your insurance may not cover the cost of the procedure. Medicare currently does not cover the use of Botox® for urologic reasons. If you have Medicare and choose to have Botox® you will be asked to sign an ABN waiver which states acknowledgement of patient responsibility for payment.

For all other insurances, coverage is not determined until the claim is received by the insurance company. For this reason you will also be asked to sign an ABN waiver stating your patient responsibility and noting that you are financially responsible for the service should your insurance not cover Botox®.