If behavioral modifications and medications are unsuccessful or not tolerated there are several operative or procedural treatments.
Botox (botulinum toxin) injection
Botox can be injected into the bladder wall to block muscle receptors and relax the bladder wall. The procedure can be done with local or general anesthesia. The provider will use a cystoscope to see into the bladder and inject Botox throughout the bladder wall. The effects can last from 6-18 months and repeat treatments are necessary.
For more information about the botox procedure, click here.
In OAB the nerve signals between the bladder and the brain do not communicate appropriately. Therefore, some therapies target stimulation of nerves to improve that communication.
There are 2 types:
Percutaneous tibial nerve stimulation (PTNS): This procedure focuses on sending electrical pulses through a nerve in the ankle that shares the same path as the bladder. In the office a small electrode is placed in the lower leg near the ankle. Treatments are initially completed weekly for 12 weeks, followed by maintenance treatments.
Sacral nerve stimulation (SNS): The treatment is an operative procedure where a small pacemaker is implanted under the skin in the buttocks / lower back. This is connected to an electrode near the sacral nerve. The misfired signals from the bladder are regulated through this pacemaker to control symptoms of OAB.