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Treating Overactive Bladder with Botox® It appears that Botox ® has more uses than just as a wrinkle-reducer. Botox®, approved for the treatment of wrinkles, can also be used to treat overactive bladder. According to a study conducted at the University of Pittsburgh, School of Medicine in Pennsylvania, injections of botulinum toxin directly into the bladder muscles can give patients relief from urinary incontinence caused by OAB, or as a complication of multiple sclerosis. Injecting the Bladder When treating an overactive bladder with Botox®, Dr. Michael Chancellor, Professor of Urology at the University of Pittsburgh, uses a fiber optic scope to locate the bladder and then injects specific muscles in the bladder with the toxin. Botox® paralyzes the muscles that cause the involuntary contractions leading to incontinence, but allows untreated surrounding muscles to function normally. Botulinum toxin, the world's most powerful toxin, is so deadly that one gram could kill a million people. The Botox® used for medical procedures is a greatly diluted, purified form of the poison. Patients receive millionths of a gram, which is enough to paralyze the muscles targeted for months. Results are Positive The results of the Chancellor Botox® study were reported at the annual meeting of the American Urological Association in May 2002. In his presentation, Chancellor described his use of Botox® in fifty people with overactive bladder and twenty-five people with multiple sclerosis. "People with [OAB or multiple sclerosis] have to wear diapers, are fitted with catheters and urine bags," he said. "Some of these people are almost hopeless." Chancellor said about two-thirds of the patients with either OAB or multiple sclerosis get enough relief from Botox® to eliminate the use of catheters and diapers, and can often discontinue medication used to control incontinence. Of the fifty patients with OAB, 41 (82 percent) reported a decrease or cessation in their incontinence after treatment. The injections work for about six months and then the condition returns. According to Chancellor, some patients have returned for four and five treatments. So far, no problematic side effects due to the Botox® have been reported. The Downside: Cost Chancellor said the downside of using Botox® to treat urinary incontinence is its cost. With a bladder procedure using two, sometimes three 100 unit vials, at $400 a piece, treatment with Botox® can be quite costly. Unfortunately, the use of Botox® to treat urinary incontinence does not have FDA approval. So even though it may be the only way to get relief for some OAB suffers, insurance companies will often not pay for the procedure. Because Botox® is not yet approved for use in this manner, "only people who can afford the expense of the treatment get it, or they get less of a treatment that would produce optimal results," Chancellor said. Chancellor has approached the manufacturers of botulinum toxin about sponsoring a study to prove its worth in treating urinary incontinence. His efforts, so far, have not been productive. Resources Science Daily. (2002). University of Pittsburgh researchers use Botox® to treat overactive bladder. Retrieved August 20, 2002, from http://www.sciencedaily.com/releases/2002/05/ 020527081316.htm. Susman, E. (2002). Botox® relieves urinary problems. Retrieved August 18, 2002, from http://www.upi.com/view.cfm?StoryID=27052002- 043708-1001r.

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