Tarlton said:
Am I being ridiculous for something that has a 90% chance of not happening?
Not at all. Your concerns are real and valid, and deserve to be addressed.
I've had many rounds of Botox, and I've corresponded online with a number of other people who've had it. Personally, I think the odds are above 10% that you'll have urinary retention, though I don't have actual statistics to back up that idea. Most people I've talked with have ended up having to self-cath at least for a while. On the other hand, I think the 20% UTI figure is high; I've been self cathing for years because of Botox, and I've had only one UTI (and that one was hospital-acquired - we all know there are lots of nasty bugs running around in hospitals!)
Having to insert a catheter is the elephant in the room with Botox. Again, all I can do is share my experience. I was terrified of having to self cath; I've had several cystoscopies and a urodynamics test, and having something put into my urethra was absolutely the worst part of any of that. When I had urodynamics, I was literally sobbing in terror as they put the catheter in (though, as it turns out, they used a very small one that wasn't really all that bad).
When I started getting Botox around 2014 or 2015, I was scared of having to cath. My urologist started me with a supply of red rubber catheters and lidocaine jelly, which was messy, hard to use, and not very comfortable. She also gave me some samples of hydrophilic catheters, and that made all the difference. They come with a sachet of water in the package, and you squeeze it to activate a lubricant coating on the catheter. I don't get the numbing of the lidocaine, but I quickly got to a point that I didn't need it. It took a week or two to get used to having to cath regularly, but my body quickly got used to the sensation, and that "I'm shoving a razor blade inside myself" feeling went away. Things that helped early on were going slow (I'd take five minutes or more to slowly insert the catheter) and using small catheters - I started with 12 Fr. (about 4mm diameter), but later once I was used to them went to 14, then 16, and now 18 Fr. (6mm diameter) because they're actually easier to put in because of the increased stiffness of the catheter.
When you get the Botox, I would suggest that you talk with your doctor ahead of time and insist on being given enough time to get numb before the procedure. Many doctors squirt lidocaine into your urethra, maybe put a little in your bladder, and immediately start the procedure. In my experience, it takes around 20 minutes for the lidocaine to really take effect, and the effect lasts around an hour, so you need some time to get numb before the scope. I've only had one doctor who left me in the exam room for a full half hour before doing the scope - and it was the easiest scope I'd ever had. He's since retired, and my new doctor isn't that patient, so I get him to prescribe lidocaine jelly in URO-Jet applicators (
https://mms.mckesson.com/product/810958/International-Medication-Systems-76329301505). These are a convenient, sterile, and painless way to get the jelly in there, and I put it in before I leave the house to go to the appointment (my doctor's office is only ten minutes away, and tends to be very timely in their appointments). You could also squirt it in when you arrive at the office, which should give it enough time to get you numb. The key thing is to relax your urinary sphincter so that some of the jelly can get all the way into your bladder, not just into your urethra; this helps make sure the experience is as painless as possible.
I also have spare URO-Jets on hand in case I do get some irritation in my urethra from cathing. It's not common, but sometimes the eyelets in the catheter can rub a little bit the wrong way and it's not super comfortable, though it's far from being painful.
As you might guess, Botox works extremely well for me, enough that it's worth the very minor hassle of having to cath. I go through 6-8 catheters a day, and I'm at the point that I can stand in front of a urinal, cath, take it out, put it back in the package and wrap it up for disposal without anybody even realizing I'm doing anything more than just peeing normally. It's really that quick and easy.
I completely understand the fear of having to cath, especially if you've had Foleys put in before or you've had cystoscopy done. Again, I can only share my own experience, but it very quickly turned into a non-issue.
I hope this helps!
