Video Presentations: AUGS Abstracts: 2005 26th Annual Scientific Meeting of The American Urogynecologic Society
This video demonstrates our technique of cystoscopic intradetrusor injection of Botulinum A Toxin for the treatment of detrusor overactivity incontinence.
The patient is placed in dorsal lithotomy position in our office treatment room. Thirty mls of 1% lidocaine is instilled in the bladder 15 minutes prior to the procedure. Two hundred units of Botox is dissolved in 6 cc of sterile injectable saline and separated into two 3 cc syringes. A single drop of methylene blue is added to each syringe to assist in visualization of drug dispersion after delivery. Using the Wolf cystoscope injection system (Richard Wolf Medical Instruments Corp, Vernon Hills, IL), including a 17 Fr scope and 22 Fr sheath, routine cystoscopy is performed. After localization of the ureteral orifices, systematic injection of the bladder dome is performed under direct visualization starting in the midline above the level of the trigone. Injections are performed at a depth just below the bladder mucosa and into detrusor muscle superficial enough to create a wheal at the injection site. Gradually working outward to each side, injections are performed at 0.5 to 1 cm intervals. Visualization of dispersion of the methylene blue stained drug through the bladder mucosa is used to indicate prior injection sites and drug delivery. Treatment is completed when approximately 20 injections using a total of 200 U of Botox are performed throughout the posterior bladder wall.
The procedure is well tolerated under local anesthesia. The patient is discharged to home and placed on 3 days of prophylactic urinary antibiotics.
Office cystoscopic intra-detrusor Botulinum A toxin injection is technically feasible and well tolerated. This video illustrates a treatment technique in an office procedure room setting under local anesthesia.