Are you using (or will you use) onabotulinumtoxinA to treat certain patients with urinary incontinence?

I think it would require a learning curve, and it wouldn't be a permanent solution because it only lasts a few months. That would, in all probability, make it a costly treatment, but it would definitely be an option when the anticholinergics don't work.

It doesn't always work. I had a patient with severe incontinence where nothing worked, so I sent her to a specialist. He treated her with the botulinum toxin with very little response, so although it would definitely be an option to be tried, it isn't 100% effective."

"I went to a seminar by Dr. Victor Nitti at New York University, who has done a lot of that research, and he had some good results with it.

I could see Botox being an effective alternative, but whether or not I would use it could depend on whether there was much government regulation; I know it used to be on a list that required government inspection of the doctor's office and logs. We do have a surgery center, and it could probably be done there."

Joel Abramowitz, MD
Jersey City, NJ

"My partner is a neuro-urologist who does Botox a lot, and taught me how to do it, so I've had the opportunity to use it about a half dozen times in the past year on patients with chronic instability.

It's a fairly easy technique to learn, patients seem to respond quite well to it, and it's one less oral medication. Polypharmacy is a concern, because usually bladder instability is not an isolated condition and patients are usually on medicines for other conditions. So I'm glad I can do something they can tolerate in the office and not have to go to the OR.

Proper selection of patients is important. They have to have some bladder contractability; you don't want to put them into urinary retention.

I've used it in both men and women, but I wouldn't use it on someone with an enlarged prostate for fear it could relax the bladder to the point of urinary retention, and the Botox can last for 6 to 9 months. That would be miserable."

Jeffrey Cooper, MD
Harbor City, CA