Hi @Pammy53.
1.
You Check-in at the front desk of your outpatient urologist's office.
2.
You provide a urine sample so they can make sure you don't have a UTI before the procedure.
3.
You undress from the bottom down in your private exam room and wait for the UTI results. Some (greedy) urologists may also do an external ultrasound over your bladder to make sure it looks healthy. It's really not necessary. My old doctor did it but my new doctor doesn't.
4.
If you're a female, you lay on the table in the OB/GYN exam position with a sterile drape over your lap. If you're a man you can probably sit up or lay down with a drape over your lap.
5.
The nurse or medical assistant comes in to insert a small, lubricated plastic catheter with Lidocaine inside it. They inject it into your bladder and your urethra to numb it up.
6.
My first doctor (a 85-year-old male) then immediately started doing the rest of the procedure so I wouldn't be numb at all, but my current doctor (a 35-year-old female) waits 20 minutes to make sure the lidocaine has kicked in. My old doctor used a solid metal catheter which is very outdated and I don't recommend it. Metal catheters are much bigger and they're inflexible. My new doctor uses plastic, flexible, warm catheters. If I were you, I would insist on waiting for 20 minutes to get numb, especially if you're the kind of person who needs extra injections or extra time to get numb at the dentist (I do). While you wait for the lidocaine to kick in, you just lay on the table waiting, alone in your exam room. You can play on your phone or read a book or magazine.
7.
After the lidocaine has kicked in, the urologist and the nurse return to the room. They insert an XL catheter because it needs to contain both the camera and the injector. On the computer screen, you can see your bladder if you want to. They move the catheter around your bladder doing different injections. The standard beginning quantity is 100 units, which should be given via 22 injection sites to different parts of the bladder so the entire bladder is equally affected by the Botox - so said my old doctor. But my new doctor says she can do it in 10 injections. I receive 200 units in 20 injections by the new lady. I have to say I think it worked a little better when the old doctor did 44 injections for 200 units. That procedure took a little bit longer, but it was kind of a more even coverage if that makes sense. In total, I think the catheter, camera, and injector is probably only inside of you for a few minutes. It does hurt. It kind of hurts like getting pricked with a skinny sewing straight pin. Our bladders contain a ton of nerves so that's why it's such a sensitive area.
8.
You may have some residual light cramping for the next few hours and want to take it easy.
9.
You may have some very light bleeding for the next day or two and peeing might sting a little bit, but nothing like the pain with a UTI.
10.
It takes 2-3 weeks for the Botox to kick all the way in for you to see it's full effect.
11.
The Botox is in full effect for three months and gradually wanes away. I choose to get another dose at the 90 day mark but some people go for six months between appointments.
Because initially it used to hurt me so bad that I kicked the doctor in the head involuntarily, he began prescribing me one pill of Percocet and Xanax to be taken together an hour before coming in to the appointment. I don't get loopy from the meds, I just get relaxed. I feel like I could drive, but it's just better not to take chances. That means I have to have a driver but it's completely worth it because I have a lot less anxiety and experience a lot less pain with those meds in board. I've done it that way for several years now and I'm no longer scared of the pain so I'm probably going to be able to move away from the meds and just go ahead with the procedure and drive myself because I'm used to it. I do recommend having somebody drive you, especially for your first appointment, in case the pain is so overwhelming for you that it distracts you while you drive home, or maybe just to hold your hand.
The cost to the insurance company is $5,000-$6,000 but the cost to you, after you've paid your deductible if you have one, is between $350-$450, depending on how many units of Botox you get. It's best to start with a lower amount of Botox units then get more in a few weeks if you need more. I get traditional private health insurance through my company. It's Blue Cross Blue Shield. Before that I had a public marketplace plan called Select Health, a local insurer. On both plans my co-pay has been the same. I have no idea what the co-pay would be with Medicare but I do know that both Medicaid and Medicare will cover Botox. When you consider the cost, just think, you're probably not going to have to wear a diaper for three months so it might actually save you money to get Botox. It will save you discomfort and embarrassment, cramping pain, etc. You almost feel back to your regular self with Botox. It doesn't work for every kind of diagnosis so you need to talk to your doctor about that. It works the best for people with Neurogenic Bladder but can help those with almost any other diagnosis, too.
