May 28, 2002
By Ed Susman
Special to DG News
Botulinum toxin injection appears to return bladder control to patients with urinary incontinence secondary to multiple sclerosis, according to researchers.
"Botulinum toxin injections are an effective and promising treatment for patients with incontinence due to problems in controlling their bladder," said Michael Chancellor, MD, professor of urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. He presented the results of two studies here Monday at the 97th annual meeting of the American Urological Association (AUA).
Dr. Chancellor described his use of botulinum toxin-commonly known as Botox-in 25 patients with multiple sclerosis and 50 patients with overactive bladder. He said patients with multiple sclerosis frequently suffer urinary problems because nerve damage caused by the disease prevents signals from reaching the external sphincter muscle. Injection of botulinum relaxed the external sphincter, and the internal sphincter at the neck of the bladder prevented unwanted leakage of urine.
For patients with overactive bladder, Dr. Chancellor located the bladder through a fiber optic scope and injected the bladder with 100 to 300 units of botulinum toxin, which calmed the bladder spasms.
"People with these conditions have to wear diapers[or] are fitted with catheters and urine bags," he said. "Some of these people are almost hopeless."
Dr. Chancellor said about two-thirds of the study patients experienced enough relief to discard their catheters and diapers, and many were able to discontinue medicine used to control overactive bladder.
The injections are effective for about six months, but the treatments are not curative and must be repeated.
"I haven't seen any unwanted side effects with the treatment," he said.
"The use of botulinum for treating overactive bladder sounds reasonable," said Thomas Brady, MD, head of the AUA's media committee and a faculty member at the University of Nevada, Reno. "The treatment is quite feasible as well. We can get needles into the bladder to make all kinds of injections, so this would not require any greater amount of expertise that doctors already have."
Dr. Chancellor said the downside of the treatment is its cost. A vial of botulinum toxin costs about $400 for 100 units of the drug. A single bladder procedure can use one to three vials. And while the treatment may be the only thing that works for these patients, insurance companies often will not pay for the injections because botulinum toxin does not have FDA approval for this indication.
Dr. Chancellor said he has urged the manufacturers of botulinum toxin to fund a study to prove its worth as a treatment for incontinence, but so far the companies have not responded favorably.
The studies were institutionally sponsored.
Copyright (c) 1995-2002 Doctor's Guide Publishing Limited