Botulinum toxin injections for an overactive bladderOveractive bladder ke liye botulinum toxin ke injection

Yeh kya hai aur kyun kiya jata hai

Overactive bladder woh bladder hai jo zyada baar ya zyada zor se sikudta hai, jis se achanak peshab ki shiddat ki hajat, baar baar peshab, raat ko uthna, aur kabhi kabhi toilet tak pohanchne se pehle peshab nikal jana hota hai (dekhein overactive bladder ki guide). Botulinum toxin jab chhoti khuraakon mein bladder ke patthay mein lagayi jaye to use dheela karti hai aur zyada sikudne ko pur-sukoon karti hai.

Yeh aam tor par us waqt tajveez kiya jata hai jab doosre ilaaj, jaise bladder training, tarz-e-zindagi mein tabdiliyan aur goliyan, kaam na karein ya un ke nuqsandeh asraat hon. Yeh us overactive bladder ke liye bhi istemal hota hai jo nasoon ke masle ki wajah se ho (dekhein neurogenic bladder ki guide).

Injection patli doorbeen ke zariye lagaye jate hain jo peshab ki nali se bladder mein jati hai, aur bareek sui bladder ki deewar mein kayi jagah injection lagati hai.

Procedure se pehle

• Zaroorat par catheter lagane ke liye tayyar rahein. Kuch logon ka bladder injection ke baad theek tarah khali nahi hota aur unhein kuch arsay ke liye din mein kayi baar patli catheter khud lagani padti hai. Faisla karne se pehle aap ko yeh seekhne ke liye razi aur qabil hona chahiye (dekhein catheter ki guide ka khud catheter lagane wala hissa). Nurse aap ko sikhayegi.
• Pehle peshab ka test hota hai. Peshab ke infection ka injection se pehle ilaaj zaroori hai (dekhein peshab ke tests ki guide).
• Tests: aap ka bahao ka test aur bladder scan ho sakta hai taake dekha jaye ke aap kitna khali karte hain (dekhein uroflowmetry ki guide), aur kabhi bladder ke dabao ke tests (dekhein urodynamics ki guide).
• Team ko batayein agar aap hamila hain ya hamila hone ki koshish kar rahi hain, agar koi patthon ya nasoon ka masla hai jis se kamzori hoti hai, aur kisi bhi allergy aur khoon patla karne wali dawaon ke baare mein. Apne taur par koi dawa band na karein.
• Bay-hoshi: injection aksar jaagte hue, local anaesthetic gel ke saath patli flexible doorbeen se, ya sedation ya poori bay-hoshi mein lagaye ja sakte hain. Team batayegi ke aap ke liye kaun si munasib hai.
• Aap se razamandi (consent) maangi jayegi. Faide, khatrat aur asar kitni der rehta hai, yeh zaroor poochhein.

Procedure ke dauran

Doorbeen peshab ki nali se bladder mein jati hai, aur bladder ko aahista paani se bhara jata hai taake deewar nazar aaye. Phir surgeon doorbeen se guzar ne wali bareek sui se bladder ki deewar mein kayi jagah chhoti miqdaar mein dawa lagata hai. Phir bladder khali kar diya jata hai.

Is mein aam tor par pandrah se tees minute lagte hain. Zyadatar log usi din ghar chale jate hain, jab woh peshab kar lein.

Procedure ke baad aur recovery

• Halki jalan aur peshab mein thoda khoon aik do din aam hai. Bohat paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho.
• Asar aahista barhta hai. Yeh aam tor par aik do haftay mein shuru hota hai aur reesna aur achanak hajat aahista aahista kam hoti hai.
• Asar waqt ke saath khatam hota hai, aam tor par kayi mahinon ke baad, aur alamaat wapas aati hain. Agar injection se faida hua ho to unhein dobara lagaya ja sakta hai.
• Dekhein ke aap kaisay khali karte hain. Agar peshab na aaye ya mehsoos ho ke bladder khali nahi ho raha to apni team ko batayein ya jaise sikhaya gaya ho catheter istemal karein.
• Sargarmi: aap aam tor par agle din apni aam sargarmiyon par wapas aa sakte hain.

Mumkina khatrat

• Bladder ka theek tarah khali na hona aur kuch arsay ke liye catheter ka istemal. Faisla karne se pehle samajhna sab se aham khatra yehi hai. Asar khatam hone ke saath yeh behtar ho jata hai.
• Peshab ka infection, jo us waqt zyada mumkin hai jab bladder theek khali na ho (dekhein peshab ke infection ki guide).
• Peshab mein khoon, jalan aur takleef aik do din.
• Bohat kam: poore jism ke patthon ki kamzori ya dhundla dikhna agar dawa bladder se bahar phail jaye, nigalne ya saans lene mein mushkil, aur anaesthetic ke khatrat. In mein se kuch bhi mehsoos ho to fauran team ko batayein.
• Asar kaafi na ho, ya umeed se pehle khatam ho jaye. Aisi surat mein doosre ilaaj par baat ho sakti hai.

Follow-up aur dobara injection

• Follow-up visit: aam tor par kuch haftay baad dekha jata hai ke yeh kitna kaam kar raha hai aur aap kitna khali karte hain (dekhein uroflowmetry ki guide).
• Jab asar khatam ho jaye to alamaat wapas aati hain, aur aap injection dobara lagwane par baat kar sakte hain.
• Agar aap catheter istemal kar rahe hain to nurse saman mein madad karegi aur batayegi ke aap kab band kar sakte hain.

Aam sawalaat

What it is and why it is done

An overactive bladder is a bladder that squeezes too often or too strongly, causing a sudden urge to pass urine, passing urine often, getting up at night, and sometimes leaking before you reach the toilet (see the overactive bladder guide). Botulinum toxin, when injected in small doses into the bladder muscle, relaxes it and calms the overactive squeezing.

It is usually offered when other treatments, such as bladder training, lifestyle changes and tablets, have not worked or have caused side effects. It is also used for an overactive bladder caused by a nerve problem (see the neurogenic bladder guide).

The injections are done through a thin telescope passed along the urethra into the bladder, and a fine needle injects the bladder wall at several places.

Before the procedure

• Be ready to pass a catheter if needed. A proportion of people cannot empty the bladder well after the injections and need to pass a thin catheter themselves, a few times a day, for a time. Before you decide, you must be willing and able to learn this (see the self-catheterisation section of the catheter guide). A nurse will teach you.
• A urine test is done first. A urine infection must be treated before the injections (see the urine tests guide).
• Tests: you may have a flow test and bladder scan to check how well you empty (see the uroflowmetry guide), and sometimes bladder pressure tests (see the urodynamics guide).
• Tell the team if you are pregnant or trying to become pregnant, if you have a muscle or nerve condition that causes weakness, and about any allergies and blood thinners. Please do not stop any medicine on your own.
• Anaesthetic: the injections can often be done awake, using local anaesthetic gel with a thin flexible telescope, or under sedation or a general anaesthetic. The team will explain which suits you.
• You will be asked for consent. Please ask about the benefits, the risks and how long the effect will last.

During the procedure

The telescope is passed along the urethra into the bladder, and the bladder is gently filled with fluid so the wall can be seen. The surgeon then injects small amounts of the medicine into the bladder wall at a number of places, using a fine needle passed through the telescope. The bladder is then emptied.

It usually takes around fifteen to thirty minutes. Most people go home the same day, once they have passed urine.

After the procedure and recovery

• Mild burning and a little blood in the urine are common for a day or two. Drink plenty of water, unless told otherwise.
• The effect builds slowly. It usually starts within a week or two, and the leakage and urgency gradually ease.
• The effect wears off over time, usually after several months, and the symptoms then return. The injections can be repeated if they helped.
• Watch how you empty. If you find that you cannot pass urine, or feel the bladder is not emptying, tell your team or use the catheter as taught.
• Activity: you can usually return to normal activities the next day.

Possible risks

• Not emptying the bladder properly, and needing to use a catheter for a time. This is the most important risk to understand before you decide. It improves as the effect wears off.
• Urine infection, which is more likely if the bladder does not empty well (see the urinary tract infection guide).
• Blood in the urine, burning and discomfort for a day or two.
• Rare: generalised muscle weakness or blurred vision if the medicine spreads beyond the bladder, difficulty swallowing or breathing, and the risks of the anaesthetic. Tell the team at once if you notice any of these.
• The effect may not be enough, or may fade sooner than hoped. In that case, other treatments can be discussed.

Follow-up and repeat injections

• Follow-up visit: you will usually be seen a few weeks later to check how well it is working and how well you empty (see the uroflowmetry guide).
• When the effect wears off, the symptoms return, and you can discuss having the injections again.
• If you are using a catheter, the nurse will help you with supplies and will tell you when you can stop.

Common questions