Treatment of overactive bladder (OAB)

Botulinum toxin infiltration

The urinary bladder - introduction

The function of the human urinary bladder is to store urine on the one hand, and on the other hand to empty itself by contraction (contracting) when the urine volume reaches about 300 - 450 ml.

The human bladder is a hollow muscle, which must initially remain relaxed during the urine filling phase in order to be able to store a sufficiently large volume of urine, and which contracts evenly (contracts) for emptying.

Muscular relaxation during the urine storage phase and contraction during the voiding phase (micturition) are controlled by the brain via sensory and motor neurons (afferent and efferent neurons). 

Due to numerous diseases, but also as a result of unexplored causes (idiopathic causes), this nerve control can be disturbed, so that there is a sudden and unexpected urge to urinate (urge) both during the day and at night, regardless of the current filling volume of the bladder. The bladder muscle reacts to this urge to urinate with uncontrolled muscle contractions. The result is an involuntary and often uncontrollable loss of urine (urge incontinence).

Causes of irritable bladder/overactive bladder (OAB) can include:

• Urinary tract infections
• Urinary bladder stones
• Nervous diseases for example multiple sclerosis, tabes dorsalis, neuromyelitis, diabetes mellitus
• Spinal cord injuries
• Diseases in the brain stem area
• Aging processes 
• Idiopathic processes (processes with unknown cause)

Symptoms of overactive bladder (irritable bladder) may include:

• Frequent urge to urinate
• Frequent urination during the day (pollakiuria) and at night (nocturia)
• Involuntary loss of urine (urinary incontinence)

Botulinum therapy for overactive bladder Munich

In the case of "overactive bladder" or urge incontinence, nerve impulses are transmitted to the bladder muscle in an increased and uncoordinated manner, triggering an uncontrolled and frequent muscle contraction of the bladder.

This process is largely prevented by botulinum injections.

Botulinum toxin type A, which in medically used dosages is non-toxic to the organism and partially blocks the increased signal transmission of nerve cells.

The therapeutic botulinum toxin administration (application) into the urinary bladder muscle causes it to relax.

The bladder is then able to store a sufficient volume of urine again and the frequency of bothersome and inconvenient trips to the toilet (micturition frequency) decreases significantly.

The unpleasant urge to urinate - that is, the feeling of having to go to the toilet frequently - is also lastingly improved as a result of a more controlled nerve impulse stimulation of the bladder muscles by botulinum toxin.

As a result, for example, sleeping through the night is possible again due to the lack of nocturia (nocturnal urination) and the ability to hold urine again (continence ability) usually makes the wearing of diaper pads no longer necessary.

Botulinum toxin therapy therefore makes it possible to achieve reliable urinary continence, which allows the patient to participate in social life again without fear of uncontrolled loss of urine (resocialization).

Botulinum toxin infiltration technique Munich

Treatment with botulinum toxin is an established minimally invasive procedure for the treatment of overactive irritable bladder (OAB) and urge incontinence.
Under a short general anesthetic or local anesthetic, the urinary bladder is mirrored via a cystoscope (endoscope) and 10 - 20 botulinum toxin deposits of 0.5 - 1 ml each are applied via a tiny cannula which is inserted into the urinary bladder muscle via the mucous membrane of the urinary bladder. The entire treatment takes about 15 - 30 minutes and is usually performed on an outpatient basis.

Aftercare in Munich

The effect of botulinum toxin begins on average two weeks after botulinum toxin application.

After treatment, an antibiotic recommended by the doctor should be taken for one to three days as protection against infection.

Two weeks after botulinum toxin instillation, urinary bladder emptying is checked by means of an ultrasound examination.

Because the botulinum toxin is gradually broken down by the organism in the period after treatment, the therapy usually lasts between six to nine months. If the old urinary urgency symptoms return, this treatment can always be repeated.

It is important that the patient follows the doctor's instructions after the botulinum toxin treatment.

Follow-up with the latest ultrasound technology in our practice

Two weeks after botulinum toxin instillation, urinary bladder emptying is checked by means of an ultrasound examination.