Botox in the uretha spinchter only,What do you think?

[tasi]

Hi everyone.I took my mom in today to have a urodynamics done on her.Ok before she had the procedure done the nurse asked her to urinate.She did and stated that she did not feel completly empty.So the nurse inserted a catheter in her to make sure,and sure enough she was completly empty.Ok moving fast foward here trying to make a long story as short as possible.Alright they had a screen showing my mother's bladder.As the doctor was filling her bladder up with the contrast solution then she asked her to tell her when her bladder just felt so FULL as to where she could not stand it anymore.Ok my mom was only able to tolerate 150 cc's of the contrast.The dr and the nurse stepped out and asked her to urinate it back out.Mom did after some pushing.It came out like a gusher! She was still sitting on this plastic like toilet.So I told her, mom you gotta be empty.Look at all of this that has came out of you.She states( I still feel full).So she sat on the toilet again for another five minutes.Then the nurse came back.Well after she asked mom how did she feel,Again she stated that her bladder still felt full.So the nurse said ok let me check ya just to make sure.She was still hooked up to the wires so that you could still see her bladder on the screen.When we looked at the screen her bladder was COMPLETLY empty.None of the contrast was in her anymore.Ok we went into a regular room after she got dressed.The dr suggested the botox,but she wants to put it in her uretha spincther instead of her bladder.She states that her uretha is tight and spasming and not her bladder itself.She says that she has good bladder pressure and by her having a small bladder that 150 cc's was not bad at all.I asked her how much botox did she want to inject in her uretha spincther.She said 200 vials.I was telling her about some of the experiences that people have had with using 200 in the bladder itself and how a lot of women were in great discomfort afterwards.She states that this is in a different place.I asked her what did she think about lowering the amount in her uretha.She was in disagreement with injecting in less than 200 vials.So I guess I was wanting to know was what do you think about 200 vials going into her uretha spincter? Have you known anyone to just have had it injected in that place only? Oh also she is starting physical therapy with her uro-gynecologist.The uro-gynecologist just deals with pain and physical therapy to help her release those tight muscles.And her urologists deals with the major stuff that comes with ic.She is the only dr up here that does deal with ic.What do you think about the injection as far as her injecting it in the uretha and the amount of vials? I hope to get plenty of responses.
God Bless You All angel
Thank You
Tasi

[ICB]

Has the doctor discussed bladder retraining with your mom? It may take a while, but she could help increase the capacity of her bladder. What other therapies (oral and/or physical) has her doctor tried. Botox is still in clinical trials and it should only be considered when other therapies have failed.

There is a doctor (Christopher Smith, MD) with the Neurourology Lab at Baylor College of Medicine, in Houston, TX. He is currently running a clinical trial on Botox with 10 IC patients. He has injected at least one patient in the urethra. If I remember correctly, it was with less Botox than what your mom's doctor is recommending. Maybe your mom's doctor can contact him and ask him for suggestions.

I suggest that you consult with your healthcare provider if you believe that the information above may be helpful; your healthcare provider will determine the appropriate treatment regimen for you.

The contents in this post are provided for informational purposes only. The contents are not intended in any way to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition.

Best wishes,
ICB

[liz2]

I wish the botox had been injected in my urethra and spincther as well as my bladder. Only my bladder was injected.

In my opinion, less is better--no matter where the injection site(s) is. We used 2 vials, and I would have done better starting with 1 vial only. Usually the uro gets 100 injections per vial of botox used. Could you get the uro to clarify what is meant by 200 vials. Surely, this means 100 shots per vial and translates into using 2 vials of botox.

I would highly recommend pelvic floor therapy. I wish I had tried that and biofeedback first.

Would the interstim be an option to try before commiting to botox injections? It helps with urgency and frequency. I personally would exhaust every option before I tried botox. However, this is just my own opinion.

I did not get the results that I had hoped for with botox. Keep in mind the fact that botox is still very experimental. Dr. Smith has not reached the clinical trial stage yet--to the best of my knowledge.

[Flore]

I agree with ICB. I have IC and a very big problem with my pelvic floor. Botox is (in my opinion) a great choice when another therapy doesn´t work

I proved pelvic floor therapy, and biofeedback, but don´t help me, in fact, my Ic was worse until I was with these treatments

The first time I have the injections were only in my sphincter, and wooow!!!, they really helped me

The other injections were inside my bladder, in my sphincter and in my vagina, and for me is the only treatment that works in me

The bad part of this is that I have to be at the hospital every 4 or 5 months

In México Botox is aproved, and the patients that have received it works perfect in our urinary tract

I have asked several times to my Dr (he is one of the 2 drs that put Botox in México) about the dose, and he prefers inject only 1 vial (100 units)

If you have another doubt, you can contact me

Bye!!!

Liz2, how are you doing???

[liz2]

Flore has a lot more experience with Botox than I do. Maybe she helped answer some of the questions.

Botox here in the U.S. is considered "off label," that means its use in the bladder has not been approved by the FDA.

I checked and Dr. Smith does not have Botox at the clinical trial stage. He is using it experimentally for patients whom he considers good candidates. Those are usually individals who have failed at all other treatments and still have unmanageable IC.

At some point your mother is going to have to put her trust in a doctor and go forward with a treatment plan that will help her. For her, Botox could be the answer.