Johns Hopkins Health Alert
Should You Try Botox for Nocturia?
In this excerpt from a recent Prostate Disorders Bulletin, a reader asks: “What are your thoughts on the use of Botox injections of the prostate and bladder base as a treatment for chronic frequent nocturia? I have tried a variety drugs for this urination problem but they cause insomnia and daytime sleepiness. I was hoping that Botox might work for me. “ Dr. Jacek L. Mostwin answers …
Dr. Mostwin: Botox has been used for the treatment of bladder overactivity due to spasms of the bladder in neurological disease and in some cases of bladder overactivity for which there are no defined causes. The FDA does not approve it for this purpose, so treatment must take place in a controlled study. Botox has not been studied for treatment of nocturia alone, regardless of cause.
Nocturia is a special form of urinary urgency that awakens the patient at night with the desire to void. Sometimes it is an early sign of benign prostatic hyperplasia (BPH) irritation and obstruction, but it can also be a sign of early congestive heart failure or other troubles associated with the heart, so an evaluation is required.
Botox is made from Botulinum toxin, a poisonous material extracted from spores of the bacterium Clostridium botulinum. It prevents release of acetylcholine, the chemical transmitter released by nerve terminals to activate contraction. Botulinum toxin A, sold commercially as Botox, has been injected directly into the bladder muscle of patients with overactive bladders in an effort to relax the overactive muscles, thereby decreasing urgency and urge incontinence. Botox is not approved by the FDA for injections into the bladder, but must be used under special conditions in approved studies.
Before considering Botox, it would be much better to start with combined medical therapy for prostatic disease. The standard treatment would consist of alpha-blockers (Flomax, Cardura, Hytrin, Uroxatral) along with medication to reduce prostatic volume (Proscar, Avodart). Anti-muscarinic medications (Detrol, Ditropan, Oxytrol, Enablex, Vesicare, and similar drugs) can also be used to reduce bladder overactivity.
The number of patients with residual, severe symptoms needing Botox injections is likely quite small, so the chances are that you can be helped with something much simpler. I would probably never advise a patient to consider Botox for nocturia treatment alone, as fluid restriction and careful use of desmopressin (DDAVP, a tablet hormonal medication that reduces urine production during the night) usually do the trick.
Posted in Enlarged Prostate on January 19, 2010
Reviewed September 2011
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