Indication
- Overactive bladder refractory to medication, or when medication is contraindicated.
Technique
Thorough inspection of the bladder mucosa. Our preferred solution are 100 Units in 10ml NaCl. 
Injection in the detrusor vesicae. We prefer injecting in vertical lines beginning directly above the trigonum and going up in 0.5cm steps. 
The “wheal” created by the injection. Make sure to avoid the vessels. Minimal bleeding might occur.
Contraindications
- Urinary retention.
- Bladder malignancy.
Complications
- Generalized muscle weakness (extremely rare).
- Allergic reaction.
- Bladder pain or discomfort.
- Persisting hematuria.
- Urinary tract infection.
- Bladder emptying disorder from a mild increase in post-void residual volume up to urinary retention with need for intermittent self-catheterization.
Postoperative Management
- Early discharge after proving normal urination.
- Follow-up in 10 days (maximal effect).
- The effect may last from 6 months to 1.5 years, the patient is encouraged to return when symptoms do.
- Discontinue anticholinergic medication.
Bibliography
- Pannek, J. Überaktive Blase – wann welche Therapie?. Urologe 56, 1532–1538 (2017). https://doi.org/10.1007/s00120-017-0522-1
- Orasanu, B., & Mahajan, S. T. (2013). The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian journal of urology : IJU : journal of the Urological Society of India, 29(1), 2–11. https://doi.org/10.4103/0970-1591.109975
Gynaecologia 