NICE guidelines refer to the management of urinary incontinence in women only.6
- 1.4.44 After a local MDT review, offer bladder wall injection with botulinum toxin type A to women with overactive bladder caused by detrusor overactivity that has not responded to non-surgical management, including pharmacological treatments.
- 1.4.45 Consider treatment with botulinum toxin type A after a local MDT review for women with symptoms of overactive bladder in whom urodynamic investigation has not demonstrated detrusor overactivity, if the symptoms have not responded to non-surgical management and the woman does not wish to have other invasive treatments.
- 1.4.46 After a local MDT review, discuss the benefits and risks of treatment with botulinum toxin type A with the woman and explain:
• the likelihood of complete or partial symptom relief
• the process of clean intermittent catheterisation, the risks, and how long it might need to be continued
• the risk of adverse effects, including an increased risk of urinary tract infection
• that there is not much evidence about how long the injections work for, how well they work in the long term and their long-term risks