Are you using (or will you use) onabotulinumtoxinA to treat certain patients with urinary incontinence?

June 1, 2012

Urology Times asked urologists if they would use botulinum toxin to treat urinary incontinence.

I think it would require a learning curve, and it wouldn't be a permanent solution because it only lasts a few months. That would, in all probability, make it a costly treatment, but it would definitely be an option when the anticholinergics don't work.

It doesn't always work. I had a patient with severe incontinence where nothing worked, so I sent her to a specialist. He treated her with the botulinum toxin with very little response, so although it would definitely be an option to be tried, it isn't 100% effective."

"I went to a seminar by Dr. Victor Nitti at New York University, who has done a lot of that research, and he had some good results with it.

I could see Botox being an effective alternative, but whether or not I would use it could depend on whether there was much government regulation; I know it used to be on a list that required government inspection of the doctor's office and logs. We do have a surgery center, and it could probably be done there."

Joel Abramowitz, MD
Jersey City, NJ

"My partner is a neuro-urologist who does Botox a lot, and taught me how to do it, so I've had the opportunity to use it about a half dozen times in the past year on patients with chronic instability.

It's a fairly easy technique to learn, patients seem to respond quite well to it, and it's one less oral medication. Polypharmacy is a concern, because usually bladder instability is not an isolated condition and patients are usually on medicines for other conditions. So I'm glad I can do something they can tolerate in the office and not have to go to the OR.

Proper selection of patients is important. They have to have some bladder contractability; you don't want to put them into urinary retention.

I've used it in both men and women, but I wouldn't use it on someone with an enlarged prostate for fear it could relax the bladder to the point of urinary retention, and the Botox can last for 6 to 9 months. That would be miserable."

Jeffrey Cooper, MD
Harbor City, CA