Botox Over Time for the Bladder

Overactive bladder patients move from Botox treatment to others after three years

January 29, 2013 / Author:  / Reviewed by: Robert Carlson, M.D

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(dailyRx News) You may already know about the wrinkle-reducing powers of Botox. Scientists have shown that Botox also works well in treating bladder problems. However, it's still unclear how long patients actually stick with the treatment and what prompts them to stop.

A recently published study found that almost two-thirds of patients who used Botox for their overactive bladders stopped getting the injections after three years. Problems with inserting their own catheter and urinary tract infections are to blame for stopping treatments over time.

The findings show trends in how patients treat their bladder troubles and the difficulties they face in controlling symptoms, which can affect their overall quality of life.

"Ask your doctor about Botox for bladder problems."

The study, led by Amar Mohee, clinical research fellow at the University of Leeds, looked at how long patients with overactive bladders kept up with their Botox treatment, also called OnabotulinumtoxinA.

Mohee, who was in the Department of Urology at St. James University Hospital while conducting the study in the UK, and colleagues also aimed to find out why patients stopped getting Botox injections for their symptoms after several years.

More than 260 patients were included in the study over a seven-year period. Patients received Botox injections for their overactive bladder at St. James University Hospital.

Researchers checked on patients two to four weeks after the first injection as well as two to three months later.

During the follow-up visits, patients were able to change their treatment or keep getting Botox injections about every eight months.

Other treatments were offered if Botox did not work, but researchers said that was rarely the case.

Researchers found that among the participants who continued with the study, about 62 percent of them stopped Botox therapy after three years. About 64 percent of patients discontinued treatments after five years.

Among patients who continued to have injections, 80 continued to follow-up, more than five years after the first injection.

There were few differences between patients who stopped the Botox injections and those who kept going with them.

Participants who could not hold their bladders at the start of the study were more likely to stop the Botox treatment than those who were 'dry' and could hold their bladders, researchers said.

In addition, patients who were older than 50 years of age were more likely to continue treatment than younger patients.

The main reasons patients stopped getting Botox injections were urinary tract infections (UTIs) and the inability to insert their own urinary catheter, according to the researchers.

More than half the patients who stopped Botox injections returned to some management plan that focused on lifestyle changes and other kinds of medication to treat their overactive bladders.

Researchers said in their report that they were not sure why patients who developed UTIs and those who had problems with their catheters didn't stop Botox injections earlier on.

"We wonder whether this was a [health-related quality of life] issue, in that the patients initially enjoyed the improved symptomatic relief from the [Botox] therapy after switching from conservative management and noticed a significant improvement in their urinary symptoms and in their [quality of life]," researchers said.

The decline in Botox injections over time, according to the researchers, could have resulted from patients being inconvenienced by having to repeat treatments and dealing with side effects from Botox that hindered their quality of life.

Overactive bladder and all that comes with it - the urge to go and the number of trips actually made to the bathroom with or without losing bladder control - is difficult to manage, according to Tristi Muir, MD, associate professor in the Department of Obstetrics and Gynecology at the University of Texas Medical Branch, Galveston, and dailyRx Contributing Expert.

"Most of our treatment strategies (medications, physical therapy, lifestyle choices and treatment for refractory cases like intravesical botox and neuromodulation) are fraught with discontinuation," Dr. Muir said.

"Finding the strategy that the patient will continue with for years and years can be a challenge."

The authors noted that Botox was not licensed for bladder use in the UK during the study period.

In addition, patients rather than a doctor or health professional reported how often participants had the injections, and the findings may not be generalized to other populations.

Future research should repeat the study on other populations and medical centers, the authors said.

The study was published in the January issue of BJU International. No conflicts of interest were reported.

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Review Date: 
January 22, 2013
Last Updated:
January 2, 2014