September 30, 2003
Surgeons are using Botox injections to end the misery of urinary incontinence.
Urologists say thousands could benefit from treatment with a weakened version of the deadly nerve poison botulinum.
Surgeon Prokar Dasgupta, from Guy's Hospital in London, is pioneering the technique in the UK in collaboration with neurologists from the nearby National Hospital for Neurology and Neurosurgery.
Using minimally invasive surgery, he has so far successfully treated more than 45 patients.
As many as 30 per cent of those suffering from urinary incontinence fail to respond to tablets which aim to control the condition.
Until recently the only option was major surgery, in which a urologist would take a piece of bowel and enlarge the bladder so patients needed to urinate less.
Now there is hope that the Botox procedure will be the main choice for those whose problem can't be controlled by tablets.
The 15-minute operation involves feeding a flexible tube into the bladder through the urinary tract.
A syringe is fed down the tube to inject the patient. In the procedure (under local anaesthetic) as many as 30 injections are made into the muscle wall of the bladder.
The Botox relaxes the bladder so it doesn't contract frequently. This contraction is what causes sufferers to rush for the toilet.
While the treatment will not help those who have lost all control of their bladder, it will help those who still have some. The bladder is controlled from nerves that run down the spinal cord, and if these are damaged or affected by illness or accident, control of the bladder can be completely or partially lost.
Mr Dasgupta is working with patients who have suffered neurological damage, but the treatment can help any patient who has lost bladder control.
The Botox acts by blocking the action of acetylcholine - a chemical in the wall of the bladder which can make it overactive. 'Although we are using Botox, a poison, it is in relatively minor amounts, and there have been no adverse reactions,' says Mr Dasgupta.
The Botox jabs, like those used on wrinkles, eventually wear off after about six to nine months.
Patients can then undergo another course of injections.
Doctors believe patients with long-term bladder control problems could be maintained indefinitely on Botox treatment.
One of the first patients to undergo treatment at the National Hospital was Melita Macrory, a 50-year-old landscape artist from Hackney, East London, whose customers include Prince Charles.
She first experienced loss of bladder control five years ago. She says: 'I suspected there was something medically wrong and I went to my GP. He referred me to a urologist, who dismissed my concerns.
'Several months later - with the problem still occurring - I slipped on a beach. I had lost my balance for no obvious reason.
'I went back to my GP, who looked concerned. He asked to stroke the sole of my foot with a feather. It was strange request, but afterwards, he said he thought I had multiple sclerosis [MS].
'He referred me to a neurologist, who confirmed the diagnosis. Then I saw Mr Dasgupta and had my treatment last November. There was a little discomfort: I could feel the injections, but it was bearable.' Melita's treatment has worked well for almost a year, but now the effects are wearing off and she is scheduled to have more injections.
'It is a smashing treatment,' she says. 'I have an advanced form of
MS, which means I am often in a wheelchair. That's bad enough to live with,
but losing bladder control made it worse.'
Copyright © 2003, Daily Mail