Intravesical Botox

Botox (Onabotulinum Toxin-A) is a medication that is injected into the muscle to decrease its ability to contract. It is used in the bladder muscle to prevent the bladder from squeezing too much, causing symptoms of urgency, frequency, or urine leakage. Botox is commonly used in patients with overactive bladder who do not tolerate oral medications, or in whom the medications are not effective.


  • For most patients, Botox will be injected in the cystoscopy suite at the hospital. Please review the Cystoscopy webpage for more information.
  • When you first arrive, you will be asked to change into a gown.
  • The cystoscopy nurses will then take you to a separate area where they will place a small catheter into your bladder. Lidocaine will then be injected into your bladder to numb the lining. This will make the procedure more comfortable.
  • We will leave the medication to sit for approximately 45 minutes.
  • You will then be brought into the cystoscopy suite where you will meet your doctor.
  • The cystoscope will be advanced into your bladder, and your doctor will inspect the lining of the bladder. Sterile fluid will be injected into your bladder so that it is quite full.
  • A needle will then be advanced through the channel of the cystoscopy.
  • The needle will be inserted into the wall of the bladder. This can be uncomfortable, but the procedure is very short.
  • The medication will be injected into the muscle of the bladder.
  • The cystoscope will be removed and you will be encouraged to empty your bladder.

Risks and side effects:

  • Common side effects of the procedure include:
    • Bleeding in the urine for 1-3 days after the procedure
    • Mild pain or discomfort when voiding for the first 24-48 hours
    • Urinary tract infection occurs in 10-15% of patients
  • Rare but serious side effects include:
    • Difficulty passing urine after the procedure
    • <5% of patients will require a catheter to empty the bladder
    • Allergy to botox (<1/250 people)
    • Generalized weakness of legs and arms (<1/250 people)