30 August 2019, Tim Burton -
Overactive Bladder (OAB), an inability to hold the bladder, affects more people than either diabetes, asthma, or osteoporosis, and although it can ruin a life, most people have never heard of it. For those that struggle with OAB, life can be really difficult as they find themselves rushing to find a toilet at any moment of the day, to avoid an accident.
OAB affects a little over 8 million people in the UK, which means that around 1 in 8 people experience it. You are considered to have OAB if you find yourself regularly rushing to the loo because you cannot hold your bladder.
Whilst those people with a healthy bladder are able to hold their pee in for as long as they need to, patients with OAB will find it almost impossible to do that. If you have are suffering from OAB you may find yourself suddenly desperate for the loo and you will have to find a toilet in time or risk wetting yourself. In addition they pass urine very often in the day and have to wake up at night to pass urine which can have a huge impact on sleep.
Needless to say, this is an awful experience for the 1 in 8 people in the UK that are affected by it. For some people it makes attending a meeting very difficult, as they may suddenly have to rush out. It can also mean trips to new places are very tough, as they always have to know where the nearest toilets are. Attending anything from a concert to a football match or a cinema becomes tricky as they urgently leave their seat mid-way through to find a toilet.
It’s not uncommon for embarrassment and fear to lead people to become housebound, afraid to leave their home in case they cannot find a toilet in time.
In the early 2000s a team in Switzerland began to test the use of Botox as a treatment for patients who have OAB because of neurological conditions, such as spinal cord injury, or MS. Botox (Allergan, Ltd) is short for Botulinum toxin and one of the world’s most deadly poisons. It’s used in patients to treat OAB when lifestyle and dietary advice as well as medications to treat the problem have failed. In years gone by the next steps would have been complex surgery on the bladder to increase its holding capacity with the use of bowel patch (augmentation cystoplasty).
In 2005 The Urology Foundation funded Mr Arun Sahai to research using Botox to treat patients with OAB but with no associated neurological condition. The vast majority of patients with OAB don’t have a known neurological condition, and finding a treatment for these patients could have an enormous impact.
Working with Professor Prokar Dasgupta and Professor Shamim Khan, Arun was able to run the world’s first level 1 double blind placebo controlled trial of Botox as a treatment for idiopathic OAB.
When Botox is injected into the bladder muscle (detrusor), it has the effect of paralysing it. Arun’s trial showed that patients whose bladders were overactive during the filling or storing phase of the ‘peeing’ process were able to hold more urine and the urgency related incontinence either improved or resolved completely. The treatment was shown to improve symptoms and quality of life in the study. A small proportion will develop voiding dysfunction and will need to self-catheterise for a few weeks to months. The treatment is not permanent and, if successful, repeated injections are required typically every 6-12 months.
Thanks to the funding Arun received from The Urology Foundation he was able to start using the new Botox treatment on his patients at the UK’s first dedicated Botox clinic at Guy’s Hospital. This clinic is now celebrating its fifteenth anniversary and has reviewed and treated approximately 3,000 patients. The clinic currently injects close to 200 patients each year. The clinic was also one of the first to promote delivery of the injections in an outpatient setting under local anaesthetic.
At the start of the journey Botox was unlicensed but thanks to large scale company sponsored trials the treatment got formally approved for use and now appears as standard of care in all international guidelines in managing refractory OAB. It is quite remarkable how one of the most powerful toxins known to mankind is helping the lives of so many who otherwise would suffer at the hand of their OAB, and we’re proud that TUF research made it happen.
Botox treatment is now transforming millions of lives across the world. Help us fund more revolutionary research by donating today.
