What is an Anti-spasm Bladder injection?
The anti-spasm agent is a protein substance that has a powerful muscle paralytic effect and has been used in medicine since the 1960s. It is commonly used for muscle spasm disorders and in plastic/cosmetic surgery.
What urological conditions does the Anti-spasm agent treat?
The anti-spasm agent has been used to treat the following urological conditions:
Detrusor sphincter dyssynergia (DSD)
Overactive bladder (OAB)
Patients with OAB often complain of the frequent need to urinate and sometimes urinary incontinence when they cannot get to the toilet fast enough. In those who have failed oral bladder-calming medications (refractory OAB), Anti-spasm bladder injection or sacral neuromodulation are the next lines of treatments. Both are considered minimally invasive procedures.
The anti-spasm agent is effective in treating OAB secondary to idiopathic (unknown) and neurogenic causes. Neurogenic causes include Parkinson’s, multiple sclerosis, stroke etc. When injected into the bladder, it paralyses the bladder muscle wall and results in relief or resolution of the bladder symptoms (success rate is about 80%). The patient will start noticing an improvement at about 7 days after the injection. Typically the effects last for about 6 to 10 months and the patient will need more ‘top-up’ injections, if the symptoms recur.
Detrusor sphincter dyssynergia (DSD)
Some spinal cord injury patients are unable to coordinate a simple bodily function like urination. During normal urination, the brain tells the bladder to contract and at the same time, the sphincter (ring of muscle under the bladder opening which squeezes or relaxes to control continence) will relax to allow urine to flow through. In DSD patients, when the bladder contracts, the sphincter does not relax. This result in difficulty passing urine and the bladder can build up enough pressure to cause kidney damage.
Anti-spasm agent injection into the sphincter muscle can cause it to relax and allow urine to flow through. The effects last about 2 to 3 months and patients may need repeat injections.
In Australia, this procedure is now approved for patients with neurogenic OAB (spinal cord injury, spina bifida, multiple sclerosis) and will be approved for those with idiopathic OAB (Nov 2014).
How is Anti-spasm bladder injection done?
The procedure takes about 15 minutes to do and is usually done as a day-case. It can be done under local or general anaesthetic. If you have it done under local anaesthetic, a solution will be infused into your bladder for about 15 minutes via a catheter to numb the bladder before the injections. You will be given antibiotics through a drip during the case.
A cystoscopy is first done to visualise the bladder, and a special needle is passed down the scope to deliver the injections. Typically, the anti-spasm agent is injected into 20 to 30 sites (1ml each) in the bladder.
What are the side effects?
Anti-spasm bladder injection is a very safe procedure. To date, there have been no deaths reported.
Most patients will have minimal or no side effects.
The immediate side effects you will notice are some burning when you pass urine and some bleeding in the urine. These should settle down within a day or two.
A bladder infection may present as persistent burning during urination, smelly urine, cloudy urine, frequent need to pass urine and low grade temperature. If this happens, you need to get your urine tested and be started on antibiotics.
In about 5% - 10% of patients, the anti-spasm agent may be too strong and ‘overparalyse’ the bladder such that the bladder cannot contract fully to empty itself during urination (urinary retention). These patients will be taught how to drain their bladder by self-inserting a catheter a few times a day (intermittent self-catheterisation). Typically, the patient has to do this for about 6 weeks until the anti-spasm agent starts to wear off and the bladder partially recovers.
Rarely, patients may experience flu-like symptoms and may need to be admitted to the hospital.
How do I prepare for it?
You will be asked to do a urine test to check for infection prior to the procedure. If you have an infection, this has to be treated first before the procedure.
If you are on certain blood-thinning medications (aspirin, warfarin, Plavix, Iscover), you may be asked to withhold them 5 to 7 days before the procedure.
You will be given information on how to do intermittent self-catheterisation as there is a 5% - 10% chance that you may have to do it, if you are unable to pass urine.
If you are already on a bladder-calming medication, you will be asked to stop it a few days before the injections. The combined effect of the medication and the anti-spasm agent may be too strong and result in the inability to pass urine.
What happens after the procedure?
Immediately after the procedure, you should be able to go home after you successfully pass urine. If you cannot pass urine (5% - 10% chance), a catheter will be inserted to drain the bladder. You may be sent home with the catheter for a short time, and then you will be taught to do intermittent self-catheterisation (ISC).
If you have a general anaesthetic, do not drive home yourself. You can resume normal activities after the anaesthetic wears off. Drink plenty of fluids at home.
You will be given a follow-up appointment after the procedure.