Those suffering from intractable urinary incontinence may now obtain relief both physically and financially following the recent addition of botulinum toxin type A onto the Pharmaceutical Benefits Scheme. Under the Medicare funded Botulinum Toxin Program, eligible patients are now able to receive treatment for urinary incontinence due to idiopathic overactive bladder (iOAB).
The treatment involves 20 injections of botulinum toxin into various sites of the detrusor muscle, which forms the wall of the urinary bladder. The neurotoxic effects of Clostridium botulinum toxin type A inhibits the release of acetylcholine from nerve terminals. One of the many functions of the neurotransmitter acetylcholine is to act on the smooth muscles of the bladder causing contraction and subsequent voiding. An excess of acetylcholine has the propensity to result in excessive bladder contractility. Botulinum toxin acts to modulate the levels of acetylcholine thereby resulting in relief of an overactive bladder.
Improvement is usually seen after two weeks and subsequent injections may be administered after the clinical response from the previous injection has diminished, but no sooner than three months.
Contraindications include patients with myasthenia gravis or Eaton Lambert syndrome, presence of concurrent infection at the proposed injection site(s), acute urinary tract infections and patients unwilling or unable to self-catheterise post treatment due to the potential of over paralysis of the bladder muscle causing urinary retention.
- Karsenty G, Denys P, Amarenco G, De Seze M, Gamé X, Haab F, et al. Botulinum toxin A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. Eur Urol. 2008; 53(2): 275–87.
- Medicare Australia. Botulinum toxin. Canberra: Department of Human Services; 2015.
- Schedule of Pharmaceutical Benefits. Botulinum Toxin Type A. Canberra: Australian Government Department of Health; 2015.
- Smith C, Chancellor M. Botulinum toxin: clinical uses in urology. AUA update series 2008; 27(15).