The botulinum toxin thereby paralyzes the bladder muscle

Overactive bladderIn Germany, more than 6 million people are affected by overactive bladder (uAB). The frequency in the adult population is ca. 11 to 16 percent. Increases with age. Women and men are affected to about the same extent.

Patients with overactive bladder suffer from an excessive urge to urinate, have to run to the toilet very frequently, and sometimes lose urine when the sudden urge to urinate shoots in. This form of urine leakage is also called urge incontinence. Overactive bladder is also known as an irritable bladder.

About half of the patients are considerably impaired in their quality of life by an overactive bladder. Thereby ca. 40.000 falls, 12.000 fractures and 26.000 cases of depression due to an overactive bladder.

Causes of overactive bladder can be an underlying neurological disease or previous pelvic surgery. In the vast majority of cases, however, the cause is not known. This is called idiopathic overactive bladder.

It is estimated that only about half of all patients with an overactive bladder in need of treatment talk to their doctor about this topic out of shame. In the meantime there are many therapy options to help these patients.

Therapy options for overactive bladder

According to international medical guidelines, conservative therapy measures, such as pelvic floor exercises, bladder training or behavioral measures are recommended first. However, most patients can be treated effectively with drug therapy. The drugs prescribed are the group of anticholinergics or mirabegron, based on a new group of active ingredients. Although more modern medications have significantly reduced side effects, the majority of patients discontinue these medications over the course of a year, leaving them inadequately treated.

Today, other minimally invasive, reversible procedures are available to patients, such as therapy with a pelvic floor pacemaker or the injection of botulinum toxin A (Botox), if no satisfactory result could be achieved with the previous measures. Both methods have different characteristics, so that in many cases the patient can decide for himself whether he prefers therapy with a pelvic floor pacemaker or injection with botulinum toxin

Therapy with a pelvic floor pacemaker (sacral neuromodulation)

This procedure is also used scientifically sacral neuromodulation called. With more than 300.000 implantations worldwide, this procedure is considered safe and has few complications. In this surgical procedure, an electrode is implanted under X-ray control to the sacral nerves that control the bladder and rectum. A pelvic floor pacemaker implanted in the buttocks then delivers weak electrical impulses to the sacral nerves via the electrode (see Fig.), so that the signals of the excessive urge to urinate on the way to the brain can be suppressed. The advantage of this procedure is that the subsequent treatment result can be predicted well via prior test stimulation. In addition, unlike botulinum toxin, bowel dysfunction or an underactive bladder can also be treated with this pelvic floor pacemaker. Patients can use a remote control to switch the pacemaker on or off themselves, or even just change the intensity. Most often, the pacemaker is set below the perception threshold so that patients do not feel the stimulation.

Although pelvic pacing is still largely unknown, the procedure has been used successfully for more than 20 years. In most cases, a stable long-term result can be achieved. However, the pacemaker must be replaced in a minor procedure about every 5 to 7 years. Irreversible complications or permanent damage have not yet been described with this procedure.

The botulinum toxin thereby paralyzes the bladder muscle

Principle of a pelvic floor pacemaker

Injection of Botox

Alternatively, an injection of botulinum toxin A can be given into the bladder. The botulinum toxin paralyzes the bladder muscle in the process. Thus suppresses the contractions of the bladder muscle. The procedure is a simple, short operation, but often performed under short anesthesia as well. Since the effect of botulinum toxin wears off over time, the procedure must be repeated every 6 to 9 months. Urinary retention requiring sterile disposable catheterization, although quite rare, must be considered as a possible complication.

Univ.-Prof. Dr. med. Matthias Saar as a guest on the podcast apropos gesund. Listen in with pleasure.

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