In January 2013, the US Food and Drug Administration approved the use of onabotulinumtoxinA (also known as Botox A) for the treatment of overactive bladder, thus providing another treatment option for women. Symptoms of overactive bladder have been shown to significantly improve after onabotulinumtoxinA injections compared with no intervention, placebo, pharmacological treatments, and bladder instillation technique. Before considering medical or surgical treatment, all patients in whom overactive bladder is diagnosed should receive instruction in behavioral techniques (eg, bladder retraining drills and timed voids), fluid management, or pelvic muscle exercises with or without physical therapy. Intradetrusor onabotulinumtoxinA may be a second-line treatment option for overactive bladder in appropriate patients, and consideration of its use requires shared decision making between the patient and health care provider. Patients who are candidates for onabotulinumtoxinA injections into the bladder should be counseled about its risks and possible postprocedure adverse events, including the risk of postprocedure urinary retention, urinary tract infections, hematuria, pain, and transient body weakness. Health care providers who perform onabotulinumtoxinA injections must have appropriate training and experience in treating women with pelvic floor disorders, operative cystoscopy privileges, and the ability to diagnose and manage any adverse outcomes after onabotulinumtoxinA injections into the bladder.
From the Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists, Washington, DC.
Reprints: American Urogynecologic Society, Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists, Washington, DC.
The authors have declared they have no conflicts of interest.
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Published in the June 2014 issue of Obstetrics & Gynecology. Copyright June 2014 by the American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. All rights reserved. ISSN 1074-861X. OnabotulinumtoxinA and the bladder. Committee Opinion No. 604. The American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:1408–11.