
==== Front
Investig Clin Urol
Investig Clin Urol
ICU
Investigative and Clinical Urology
2466-0493
2466-054X
The Korean Urological Association

39249927
10.4111/icu.20240236
Letter
Improving intravesical botulinum toxin-A injection technique: Reshaping the needle may benefit more
https://orcid.org/0000-0001-8555-0930
Hameed Farooq 1
https://orcid.org/0000-0002-6593-8978
Anwaar Adeel 2
https://orcid.org/0009-0000-1836-0459
Karamat Riyan Imtiaz 3
https://orcid.org/0009-0005-8638-8142
Anwar Mamoona 4
1 Department of Urology, Shalamar Hospital, Lahore, Pakistan.
2 Department of Urology, Urology Suite Midcity Hospital, Lahore, Pakistan.
3 Rahber Medical and Dental College, Lahore, Pakistan.
4 Department of Medicine, Services Hospital, Lahore, Pakistan.
Corresponding Author: Adeel Anwaar. Department of Urology, Urology Suite Midcity Hospital, 10-C Jail Road, Shadman II, Lahore 54000, Pakistan. TEL: +92-42-111643289, FAX: +92-42-35407131-36, adeelanwaar9@gmail.com
9 2024
27 8 2024
65 5 522523
10 7 2024
27 7 2024
14 8 2024
© The Korean Urological Association
2024
The Korean Urological Association
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Graphical Abstract
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pmcTo the editor:

Botulinum toxin, a purified neurotoxin extracted from clostridium botulinum, primarily works by blocking signal transmission at the neuromuscular junction through the inhibition of acetylcholine release. Recent studies suggest that botulinum toxin may also impact the release of other sensory neurotransmitters like substance P and ATP, while decreasing the axonal presence of capsaicin and purinergic receptors [1]. Botulinum toxin injection, commonly known as Botox, is a widely used treatment for various medical conditions such as overactive bladder and urinary incontinence. The procedure involves injecting small amounts of the toxin into the detrusor muscle to temporarily paralyze them and provide relief from symptoms. However, the technique of injecting Botox into the bladder wall has evolved over time, with newer approaches being developed to improve its effectiveness and reduce potential risks [23]. Endoscopic needle either with flexible or rigid cystoscope is used for injecting toxin inside bladder detrusor muscle. This may be achieved by smooth reshaping only the distal 4mm portion of the regular needle shaft and bevel at 10° angle during intravesical Botox injections and this angle never damages the scope. This differs from the previously used method of keeping the needle straight while administering the injection [4]. The primary reason for reshaping the needle tip is to ensure safety, least spillage of Botox and accuracy of placement of Botox within the bladder wall. By reshaping the needle at an angle, it may allow for better access to different parts of the lateral walls and base of bladder without having to reposition or withdraw the needle multiple times. When the needle is bent at a specific angle. Upon removing the needle, the bladder’s inner side wall can act like a flap-valve, preventing the injected drug from leaking out. The bevel facing bladder wall slides with curve of bladder while inserting needle into the wall. A reshaped needle tip may offer greater control over injection depth. Each individual’s bladder size and shape can vary significantly; therefore, blindly injecting with a straight needle may result in injecting too deep or too shallow, leading to potential complications. By reshaping the needle tip at a predetermined angle, healthcare professionals can better control the depth of injection and minimize the risk of adverse effects (Fig. 1). We have used this reshaped needle in procedures and presenting this concept.

While the traditional method of using a straight needle for intravesical Botox injections has been effective, the technique of reshaping the needle tip at an angle may offers several advantages. It may allow for more precise placement and provide greater control over injection depth. These factors can make it a preferred approach among medical professionals. Future research should prioritize large-scale validation studies, for exploration of this reshaped needle technique’s applications in various urological conditions.

Fig. 1 (A) Straight needle shown that is in practice. (B) Reshaped needle by bending 4 mm distal portion of needle and bevel at 10° angle, bevel of needle faces outside. (C) Reshaped needle before inserting injection at base of bladder. (D) Injecting at lateral wall of bladder, needle slides with curve of bladder.

CONFLICTS OF INTEREST: The authors have nothing to disclose.

FUNDING: None.

AUTHORS’ CONTRIBUTIONS: Research conception and design: Farooq Hameed and Adeel Anwaar.

Data acquisition: Farooq Hameed, Adeel Anwaar, and Mamoona Anwar.

Data interpretation: Farooq Hameed, Adeel Anwaar, and Mamoona Anwar.

Drafting of the manuscript: Farooq Hameed, Adeel Anwaar, and Riyan Imtiaz Karamat.

Critical revision of the manuscript: Farooq Hameed, Adeel Anwaar, and Riyan Imtiaz Karamat.

Approval of the final manuscript: Farooq Hameed.
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