Interview with an expert

Mr M Shamim Khan answers questions on botox in treating incontinence.

Q: What is the need for this technique?
This is a second-line treatment for patients with overactive bladder (urinary urgency with or without incontinence, daytime increased frequency and nocturia).

It is recommended for those patients who do not respond or are unable to tolerate anticholinergics because of serious side-effects.

Q: Which patients may benefit and what types of problem are associated with this method?
Any patient with an overactive bladder may benefit from this treatment, but it is only recommended for those who do not benefit from anticholinergics.

The two main problems associated with the treatment are the risk of urinary infection and inability to empty the bladder, needing self-insertion of the catheter.

Q: What does it involve? When and how is it performed?
Before treatment, patients should be assessed by the specialist with history and examination. Tests are performed to exclude any other cause for the symptoms or urinary infection.

After satisfactory baseline assessment and the patient demonstrating the ability to self-catheterise if required, botox injections are given into the bladder wall using an ultra-fine needle through a flexible telescope under local anaesthesia.

Q: In how many patients has this treatment been performed? Are there any problems with the technique?
It is difficult to give the exact international figure, but this treatment is used all over the world.

Over 200 patients have been treated at the National Hospital for Neurological Diseases & Guy's Hospital London over the past four years.

Transient flu-like symptoms, urinary infection (20 per cent) and inability to empty the bladder (10 per cent) are the most common side-effects encountered in clinical practice.

Q: How long do patients take to recover?
Patients can go home within an hour of having received the injections. Patients may experience bleeding and discomfort on passing urine for the first 24 hours.

Q: If there are any outcome statistics available, what are they?
Two randomised controlled trials - one from Switzerland and the other from Guy's Hospital, London (patients without any neurological problems) - confirm efficacy in over 90 per cent of patients.

Q: What is the cost and at which hospitals is it available?
A single treatment session in the private sector costs about £2,200. Patients receiving treatment on the NHS may be funded by primary care organisations. It is available in some of the major teaching hospitals, including Guy's Hospital.

Q: How did you get involved in this work?
Because of my special interest in management of bladder conditions. Overactive bladder is a health condition affecting about 16 per cent of patients over the age of 40. In practice, management of this condition poses a challenge.

Mr Khan is consultant urological surgeon at The London Clinic.

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