Using Botox to improve the lives millions of patients with overactive bladder syndrome

Overactive bladder (OAB) syndrome may not be a term that you have heard of, but you will likely know someone who has it. Over 8 million people in the UK experience overactive bladder syndrome.

OAB is an umbrella term for numerous bladder and urinary symptoms, stemming from sudden and uncontrolled urges to pee that are so common that they will have a negative impact on your life. Typically, this can result in disrupted sleeping due to waking up to urinate, as well as incontinence from involuntarily leaking urine.

People with OAB tend to isolate and withdraw socially due to embarrassment from their symptoms. This is exacerbated by the fact that people often believe it’s just a part of ageing, thus dismissing treatment as an option. But OAB is not a part of the ageing process. OAB is a syndrome that deserves medical attention.

Traditionally, OAB cases that aren’t managed with lifestyle changes or tablets have been treated with reconstructive surgery to increase bladder capacity. But thanks to new scientific research, much of which has been supported and led by researchers from King’s College London, a Botox-derived therapy for OAB has been pioneered.

Scientists have long understood that the urge for urination in OAB results from C-fibres – the part of the nervous system that transmits an itchy feeling. Researchers from King’s College London collaborated with the Queen Square Institute of Neurology to study this mechanism in greater detail. They discovered that the receptors P2X3 and TRPV1, which contract the smooth muscle in the bladder wall (known as the detrusor muscles), were overexpressed in patients with OAB. And their overexpression means the bladder constantly contracts, even when it isn’t full, creating the urge to urinate.

With this newfound understanding, scientists could develop a cure to target the receptors that triggers detrusor muscles. BTX-A (Botox-A) was found to inhibit the neurotransmitters that trigger bladder wall contractions, thus suppressing OAB symptoms. The paper showing these findings has had a long-lasting impact, as shown by it being one of the top five most cited papers of its journal European Urology.

And it was using this fundamental science that researchers, led by Professor Prokar Dasgupta, were able to popularise the new treatment: BTX-A injections. The 15-minute procedure involves injecting Botox-A directly into the bladder under local anaesthetic using a flexible telescope.

Nicknamed the ‘Dasgupta technique’, its first double blind, randomised controlled trial with 34 patients showed that injected patients suffered from fewer problems with incontinence and the urge to urinate. A subsequent extended clinical trial with 300 patients from multiple countries found similar effects were maintained in the long term, scoring up to 90% in Quality of Life and Satisfaction rates.

Another study also reported significant quality of life improvements, as patients gave an average score of 28.3/32 from their Client Satisfaction Questionnaires. The reduced incontinence was found to improve emotional wellbeing and make patients more willing to socialise with friends.

As well as providing better patient outcomes than bladder reconstruction, BTX-A injections are much less invasive. Not only does this avoid the dangers inherent to surgery (for example, post-operation infections), it also means patients do not need to stay in hospital for post-surgery recovery. Potential side-effects from injections are minimised by the fact that OAB symptom relief was maintained over 20 years, according to a study looking at BTX-A’s long-term impact.

Alongside this, research has shown BTX-A injections to be cost-effective. A 2018 US study compared the cost-effectiveness of several different treatments for OAB, including the BTX-A injection. The authors found that BTX-A provided the greatest gains in QALYs – this is a common metric in health policy that measures the value of health outcomes for a medical intervention. BTX-A injections cost just $32,680 per QALY; the next cheapest treatment (Percutaneous Tibial Nerve Stimulation) costs $71,126 per QALY.

NICE confirmed its cost-effectiveness in 2019, approving BTX-A as a treatment for lower urinary-tract disorders. The European Association of Urology (EAU) and the American Urological Association (AUA) also updated their guidelines in 2019 to include BTX-A injections. With its health benefits and cost effectiveness well-established, it isn’t a surprise that the Dasgupta technique has quickly become the treatment of choice for OAB.

Its international popularity is also being established with the hard work of King’s-based researchers. Professor Dasgupta alone has taught 62 people his eponymous technique, and other researchers have travelled as far as India to teach the BTX-A injection. It’s clear that BTX-A injections have significantly improved the lives of millions of patients, and that the Dasgupta technique will continue to spread through the world.