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What's new in overactive bladder treatment?

Overactive bladder (OAB) is a common condition affecting up to 1 in 6 people. It is characterised by urinary urgency, urinary frequency and nocturia. Urge urinary incontinence is often found in more severe cases.

Conventional management for overactive bladder has been to avoid bladder irritants, "retrain" the bladder and anti-cholinergic / antimuscarinic medications. Unfortunately, the medications have troublesome side effects (such as dry mouth and constipation) and lack of efficacy in a significant proportion of the population. The oral medications will alleviate some but not all of the symptoms.

Botox/botulinum toxin type A, has been used for many years for a number of neurological, pain and movement disorders.

As of 1 November 2014, Botox has been PBS approved for use by "Botox qualified urologists and urogynaecologists" in the treatment of idiopathic overactive bladder. Botox improves bladder capacity and continence by reducing bladder contractions and decreasing the sensation of urgency.

It is a simple day procedure to administer Botox. The Botox is injected through a cystoscope into the bladder wall.

The major side effect is the potential for poor bladder emptying requiring self catheterisation (occurring in about 5% of patients). This side-effect is reversible with time. Most patients with severe overactive bladder would much prefer to self catheterise (and choose the time of voiding) rather than have a urine storage problem.

North Coast Urology is very excited regarding this development. Patients no longer need to pay for the Botox medication should they be offered this treatment (that is, Botox is now a PBS medication should patients fulfil the prescribing criteria).

St Vincent's has already done a number of PBS subsidised intravesical Botox cases with excellent results. Patients usually see an improvement within 2 weeks and the effect typically lasts 6 to 9 months.

Repeat injections of Botox are usually required when the effect wears off. Repeat injections are as efficacious and there appears to be no long-term side effects.

Dr Kenny Low would be most happy to help if you are poorly responding to conventional overactive bladder treatment.