Botox (OnabotulinumtoxinA) For Treatment of Neurogenic Bladder and Overactive Bladder Symptoms: Specialized Treatment in NYC for Men and Women

by Alex Shteynshlyuger MD

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4151

Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men and women with urinary problems including frequent urination, difficulty emptying the bladder, urinary urgency and incontinence.

Botox: An Effective Treatment for Urinary Frequency, Urinary Leakage and Urge to Pee

What is Botox

“BOTOX” or the botulinum toxin protein is naturally produced by a bacterium Clostridium botulinum. When used in small doses, Botox is a safe and effective treatment for many conditions including overactive bladder.

Botox is a relatively new treatment for overactive bladder and neurogenic bladder. Studies involving thousands of patients in the past 5 years confirm its safety and effectiveness in the treatment of OAB in men and women.

Botox injections in the bladder can help patients who suffer from:

  • urinary urgency: the constant need to pee
  • Frequent urination: If you have to run to void every 2 hours or more often, Botox can help
  • Urge urinary incontinence: If you cannot make it to the bathroom when the urge to pee comes on and leak, Botox can help you with bladder control.

We have extensive experience helping men and women with severe urinary problems to regain their life back. At New York Urology Specialists we use proven Botox injection techniques and protocols.

How is Botox given for the Treatment of Urinary Urgency, Frequency and Urge Incontinence?

An initial evaluation is required for all patients. If you’re a good candidate for treatment for Botox, we will make sure that you do not have a urinary infection.

Botox procedure is performed in our office under local anesthesia.   The procedure only takes around 10 minutes – and you will be conscious but relaxed throughout.

Flexible cystoscopy is performed, which involves looking inside of your urinary bladder with a tiny camera. A cystoscope is passed through the urethra (the pee-hole).  Special Botox injector is used to deliver Botox inside the bladder.

At the end of the procedure, patients are able to go home and resume their usual activities.

Local or general anesthesia?

General anesthesia is rarely needed as local anesthesia is very effective and successful for Botox administration in the bladder.  We use a miniature flexible cystoscope to minimize the discomfort of injections.


Your bladder will be anesthetized with lidocaine gel, which is proven to be effective and safe. Once the procedure is over you will be able to resume your normal activities.

The Botox Procedure Itself

Once pain medication is given in the bladder, a cystoscope will be inserted through the urethra – or bladder opening. A cystoscope is a narrow, lighted tube which enables the urologist to see inside your bladder. You may already have had a cystoscopy during the assessment of your condition.

The Botox is then administered through the cystoscope. Multiple small injections are given into the detrusor muscle of the bladder wall. For most patients, 100 units of onabotulinumtoxinA in 20 doses are given.

Afterward, you will be allowed to relax for 30 minutes before going home. It would be unwise to drive if you have been given a general anesthesia and went to sleep.   At New York Urology Specialists, we administer Botox under local anesthesia to over 90% of patients and patients can go home alone.

You might experience some burning and a small amount of blood in urine in the first few days after Botox administration.

How often do I need to be treated with Botox for Symptoms of OAB or Neurogenic Bladder?

Studies show that for most people Botox is effective for 7-9 months.  One injection of Botox lasts on average 7 months.  More than 25% of patients get more than 1 year of benefit from a single injection. Some patients experience the benefit for as long as 4 years after a single injection.  While some patients require re-injection in 3 months while for others one injection provides benefits for as long as 4 years.

Botox: 30-minute treatment once or twice a year Improves Urinary Symptoms in Majority of Patients.

A Botox procedure takes around 10 minutes plus a half hour rest afterward. Each treatment lasts on average around 7 ½ months. In almost a third of patients, one treatment may last for a year. As it wears off and the symptoms start to return, you will need to speak to your urologist at New York Urology Specialists about a further treatment. These can be repeated for several years with good results. Treatments should not be given at intervals less than three months.

How does Botox Treat Symptoms of OAB

You will probably be familiar with the “before and after” pictures of women who have had Botox injections to smooth out their wrinkles? The toxin works by blocking some nerves which paralyze certain muscles.

In OAB the detrusor muscle, part of the wall of your bladder, which normally acts when you need to empty your bladder, contracts involuntarily, making you feel an urgent need to void and possibly resulting in incontinence, even when your bladder is not full.  Botox works by blocking the nerve action which is needed to activate the detrusor muscle in the bladder, thus preventing it from contracting, unless there is a voluntary stimulus.

In addition, Botox appears to decrease abnormal nerve signaling from the bladder which also helps with the control of urinary urgency symptoms.

If you have any questions, to schedule a consultation or if you need a second opinion, please contact us or call: 646-663-4151

We offer affordable, highest-quality urology care.  We offer weekday, weekend, and evening office hours. 

We see patients from all parts of New York City (Manhattan, Brooklyn, Queens, Bronx, Staten Island), Long Island, Westchester and New Jersey as well as other parts of the USA. We also see international patients from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.