Can urinary incontinence be treated with a combination of botox and bulking agent?

This study looked at the treatment of urinary incontinence (UI) with a combination of botulinum toxin (Botox) and polyacrylamide hydrogel (PAHG). This study showed that most patients achieved good UI control with this treatment. 

UI (urine leakage) is a problem that affects many older women, usually due to the weakening of the pelvic floor muscles. There are several types of UI. Stress UI (SUI) involves involuntary urine leakage during coughing, sneezing, laughing, or lifting heavy objects. Urgency UI (UUI) involves urinary leakage after a sudden urge to pee. Mixed UI (MUI) involves a combination of SUI and UUI. 

MUI can be treated in a number of ways. The first treatment usually involves behavioral changes, particularly bladder training and pelvic muscle exercises. Another treatment option involves injecting a bulking agent into the urethra (the tube that drains urine from the bladder) in order to strengthen its walls and prevent leakage. Polyacrylamide hydrogel (PAHG) is a bulking agent commonly used for this.  Another treatment involves injecting botulinum toxin into the bladder in order to relax the bladder muscle and reduce the urgent need to urinate.

It is not clear whether combining PAHG and botulinum toxin could be an effective management option for older patients with MUI.

55 women with MUI were involved in this study. All patients had failed to respond to previous treatments. All patients were injected with botulinum toxin and PAHG in a single intervention. Patients were followed up 4 and 12 months after treatment to monitor the effectiveness of treatment.

A patient was defined as "cured" if they had no episodes of urgently needing to urinate within the 24 hours before review, and if they were able to avoid urinating when coughing. 4 months after treatment between 42-73% of patients were defined as "cured". 12 months after treatment, between 50-73% of patients were defined as "cured".

This study showed that a combination of botulinum toxin and PAHG is an effective treatment for urinary incontinence in older women.  

This study involved a small group of patients. Larger studies are needed to confirm these results.