Apollo Hospitals offers Botox treatment for urological disorders

Apollo Hospitals announced providing of treatment for complex Urology ailments like Overactive Bladder, Neurogenic Detrusor Overactivity, Bladder Pain Syndrome and Dyssynergic sphincter by using Botulinum Toxin or Botox. Renowned Urologist from Bristol Urological Institute Dr Marcus Drake and Dr Sanjay Sinha, Senior Consultant Urologist and Transplant Surgeon, Apollo Hospitals, briefed media about Botox being increasingly used by urologists world over to address untreatable and niggling urological problems.

Botox, which is being used as a drug of late, is a neurotoxic protein produced by the bacteria Clostridium botulinum. In recent times it has been extensively used for a variety of medical problems such as spastic muscles, bladder dysfunction and squint, besides cosmetic use forreducing wrinkles on the face.

Several hitherto untreatable conditions are being treated with Botulinum toxin and urology is adopting it for treating certain urological disorders in patients who were deprived of relief from the existing treatment procedures, says Dr Sanjay Sinha, who is instrumental in making this technique popular through his lectures in India and abroad including at Johannesburg, Madrid, Kuala Lumpur etc.

Some urological conditions being treated by Botox are: Overactive
Bladder
Botulinum is an important addition to the treatment options for urinary incontinence due to Overactive Bladder (OAB). OAB is a common condition affecting about 10 per cent of the population. The problem can be particularly severe in elderly women although people of any age and either sex can be affected. Patients have a severe urgency to pass urine that is hard to control resulting in a leakage of urine into the clothes before they reach the toilet.

The first line of treatment consists of lifestyle changes, chiefly the reduction of fluid intake, tea, coffee or colas. Medication of a class known as ‘antimuscarinics’ can help a large number of patients. However, not all patients respond. For these difficult to treat patients (called “Refractory OAB”) or for those who have side-effects with the tablets making it difficult for them to continue, Botulinum toxin injection offers an attractive alternative.

Botulinum toxin is injected via a cystoscope (endoscope inserted into the bladder via the natural urinary channel) into the bladder wall. The effect lasts for about 9-10 months on average after which one needs to repeat it. Unlike the oral medicine, systemic side-effects are rare. In this difficult to control group of patients, called “Refractory OAB”, about 75 per cent patients have a good response.

Neurogenic Detrusor Overactivity
Patients with spinal cord or other nerve disorders of the central nervous system can present with severe uncontrolled bladder contractions during bladder storage. These contractions, which occur without the brain’s permission are termed “Detrusor overactivity.” In a patient with nerve disease these are termed “Neurogenic detrusor overactivity or NDO”.

These contractions can be difficult to control and lead to urinary incontinence. More importantly, they can damage the kidneys in the long term. Every time an involuntary contraction of the bladder occurs, it's like a hammer on both the kidneys. Once again, oral medication is the first line but it doesn’t work in all patients. For those with uncontrolled NDO, Botulinum toxin injection into the bladder is a very useful option.

Bladder Pain Syndrome
Bladder pain syndrome (BPS) is a perplexing problem of pain in relation to the bladder without any apparent cause. It is not hazardous in a physical sense but can be extremely debilitating to the patient. Some patients can become suicidal due to severe pain. There are several treatment options with six levels of treatment described by the American Urological Association. None of these are perfect solutions. For some patients with poor response to medicines or other bladder therapies, Botulinum toxin injections can be effective.

Dyssynergic sphincter
In some individuals, the bladder control mechanism lacks coordination and contracts instead of relaxing at the time of passing urine. Some of these patients can benefit from Botulinum injection into the sphincter. The treatment is less well standardized compared to other indications but can be useful in select patients.

According to Dr Sanjay Sinha, Apollo Hospitals at Hyderguda and Jubilee Hills are pioneering Botox treatment for patients and a large number of patients have benefited, to date about a hundred such treatment sessions have been carried out by us, he adds.

Apollo Hospitals hosted a workshop to train around seventy five Urologists from all over South India at Jubilee Hills, Hyderabad, on the occasion, Dr Marcus Drake and Dr Sanjay Sinha demonstrated the techniques related to use of Botulinum Toxin injection for difficult-to-treat bladder problems.