The Unfettered Urologist by Martha B. Boone M.D

Author:Martha B. Boone, M.D. [Martha Boone]
Language: eng
Format: epub
ISBN: 9781636980737
Publisher: Morgan James Publishing
Published: 2023-08-15T00:00:00+00:00

BLADDER BOTOX (ONABOTULINUMTOXINA A)

I have to admit that I was late to the party in using this form of therapy. One of my most respected colleagues was in on the early studies. I knew her to have great integrity but when she reported results that were too good to be true, I was skeptical. Plus, the idea of using a toxin to treat a disease seemed crazy to me. Bladder Botox had been widely used for seven years before I was willing to try it. I took the Primum, non nocere creed to heart: First, do no harm.

I’m happy to report that I was dead wrong. Botox has been used by millions upon millions with little trouble. It has been applied to multiple diseases with great clinical benefit to patients. Once I decided that I had a large patient population for whom all else had failed and would not consent to neuromodulation (my other best trick), I decided to try Botox.

It proved to be an easy in-office procedure with quick results that lasted six to 14 months. It was imperative to be certain the patient did not have a UTI at the time of the procedure and that their blood clotting was normal. It worked so well in my patients that 10% experienced short term urinary retention. It was a miracle drug in spinal cord injury patients who used intermittent catheterization to empty their bladders.

I had the occasional patient who had slight bleeding afterwards. But amazingly, 85-90% were significantly improved or essentially cured until the Botox wore off and it had to be repeated. For reasons I don’t understand, Botox seems to be absorbed in other parts of the body at around three months post procedure and needs to be repeated every three to six months. In the bladder, we routinely were able to do the Botox injections every ten to 14 months or approximately once per year in most people. In neurologic patients I used 300 units if they routinely catheterized themselves and in those with no neurological disease I used 100 units to decrease the chances of post-procedure urinary retention.

If you choose this mode of therapy, go to an experienced surgeon. It’s a simple procedure, but you want the benefit of an experienced surgeon as excellent technique improves the chances for success.

Nocturia or frequent urination at night is not always a urologic condition. Causes include:

Drinking too much fluid or diuretic fluids too close to bedtime

Sleep disorders like sleep apnea

Poor bladder emptying

Taking diuretic drugs at bedtime

Urine infection

Enlarged prostate

Poorly controlled diabetes

Heart disease with leg swelling

Anxiety

Overactive bladder

Neurological diseases

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