Functional urology · London
Botox for overactive bladder - London.
A 20 to 30 minute day-case cystoscopic injection of onabotulinumtoxinA into the detrusor - 6 to 9 months of urgency control, done by a functional urologist in a CQC-registered London unit, with CISC teaching before you consent.
Why patients choose us
- 01
A specialist functional urologist, in a private London unit
Not a general urology list. A named consultant with high intravesical-Botox volume, in a unit set up for cystoscopic day-case work.
- 02
CISC teaching before you consent
Clean intermittent self-catheterisation is taught in clinic first, so retention (5 to 15% at 100 units) is a plan, not a surprise.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private intravesical Botox costs in London.
Indicative ranges across our London partner units. Send the referral and bladder diary and we quote firm figures across two or three options.
In short
Intravesical Botox in London, all-inclusive: £2,800 to £4,500, home the same day.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultant urology assessment and bladder diary review | £250 to £450 | 30 to 45 min | Same visit |
| Urodynamic studies (if indicated) | £750 to £1,400 | 45 to 60 min | 7 days |
| Intravesical Botox 100 units (idiopathic OAB) | £2,800 to £3,800 | 20 to 30 min | Same visit |
| Intravesical Botox 200 units (neurogenic detrusor) | £3,500 to £4,500 | 25 to 35 min | Same visit |
| CISC teaching session (nurse-led) | £120 to £220 | 30 min | Pre-procedure |
| Repeat injection (6 to 9 months later) | £2,800 to £4,500 | 20 to 30 min | Same visit |
Prices vary by unit, by whether sedation is used, and by the dose (100 or 200 units). All-inclusive package pricing typically covers consultation, cystoscopy, the Botox itself, day-case fees and a 12-week phone review.
The problem
What intravesical Botox is, and how it works.
Intravesical Botox is a cystoscopic injection of onabotulinumtoxinA - the only brand of botulinum toxin licensed for use in the bladder - into the detrusor muscle at 20 sites. It blocks acetylcholine release at the neuromuscular junction, reducing detrusor overactivity and giving 6 to 9 months of urgency control before the effect wears off and the injection is repeated.
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Is Botox even the right step for you?
Only after two antimuscarinics or mirabegron have failed - otherwise PTNS, a different oral drug, or watchful waiting may be the better call.
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Worried about retention?
Retention needing CISC affects 5 to 15% of idiopathic cases. Learn CISC in clinic beforehand and it stops being an emergency.
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Want it done in a specialist unit?
A named functional urologist, a CQC-registered London day-case unit, and PTNS or sacral neuromodulation pathways if Botox is not the right call.
The journey
From referral to 12-week review - what happens, in order.
One team from first message to repeat injection - including CISC teaching and the 12-week phone review.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A couple of hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us the referral or notes
A short, confidential form. Bladder diary, antimuscarinics and mirabegron tried, previous urodynamics, and any neurological diagnosis.
- 02
Before
We come back with a recommendation
Within one working day: whether intravesical Botox fits, or whether PTNS or sacral neuromodulation is the better call. Indicative price either way.
- 03
Before
CISC teaching and consent
A nurse-led session on clean intermittent self-catheterisation before the procedure, so you are prepared if transient retention occurs.
- 04
On the day
Arrival at the unit
Arrival, a urine dip to exclude infection, and a chat with the consultant. Local anaesthetic gel, with light sedation if you want it.
- 05
On the day
The Botox injection itself
20 to 30 minutes. Flexible or rigid cystoscopy, 20 injections of 0.5 mL each into the detrusor, sparing the trigone. 100 units for idiopathic OAB.
- 06
On the day
Home the same day
A short recovery, a post-void residual check, and home within an hour or two. You can drive yourself if only local anaesthetic was used.
- 07
After
Effect at 2 weeks, review at 12 weeks
Symptom benefit starts around 2 weeks and peaks by 6. A 12-week phone review confirms response and books the next injection at 6 to 9 months.
Typical end-to-end: 1 to 2 weeks to procedure. Effect: 2 to 6 weeks. Repeat: 6 to 9 months.
When it helps
Who intravesical Botox helps - and who it does not.
The indications NICE recognises, plus the situations where Botox is set aside in favour of PTNS, sacral neuromodulation, or a different oral drug. Efficacy at 12 weeks: around 60 to 70% report significant improvement in urgency, frequency and urge incontinence.
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Idiopathic overactive bladder, refractory
Urgency, frequency and urge incontinence that has not responded to at least two antimuscarinics, or an antimuscarinic plus mirabegron.
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Neurogenic detrusor overactivity in MS
Multiple sclerosis with proven detrusor overactivity on urodynamics, causing incontinence or upper-tract risk. NICE-approved, 200-unit dose.
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Neurogenic detrusor overactivity after SCI
Spinal cord injury with urodynamic detrusor overactivity and symptoms. Almost all patients already use or are willing to use CISC.
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Antimuscarinic intolerance
Dry mouth, constipation, blurred vision or cognitive fog on antimuscarinics, with ongoing symptoms despite mirabegron.
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Prior good response to Botox
A previous injection that gave 6 to 9 months of clean control - straight to repeat, no need to re-trial oral drugs.
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Not suitable: active UTI
An untreated urinary tract infection is a contraindication. Dipstick and treat before rebooking, otherwise injection is postponed.
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Not suitable: unwilling to do CISC
If you are absolutely unwilling or unable to self-catheterise should transient retention occur, intravesical Botox is not the right option.
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Red flag: visible haematuria + weight loss
New visible blood in the urine with weight loss or a change in voiding needs a two-week-wait pathway, not a private booking.
Procedure options
Intravesical Botox sits within a family of options.
What each option involves - and where it fits alongside antimuscarinics, mirabegron, PTNS and sacral neuromodulation. Augmentation cystoplasty is a last-resort major operation and outside the day-case pathway.
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Intravesical onabotulinumtoxinA 100 units
The licensed dose for idiopathic OAB. 100 units in 10 mL saline, delivered as 20 injections of 0.5 mL each into the detrusor. Retention risk 5 to 15%.
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Intravesical onabotulinumtoxinA 200 units
The licensed dose for neurogenic detrusor overactivity (MS, spinal cord injury). Higher efficacy, retention risk 20 to 30%, CISC almost universal.
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Flexible cystoscopy under local anaesthetic
A slim flexible scope through the urethra with lidocaine gel. Well tolerated for most idiopathic OAB patients, no sedation required.
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Rigid cystoscopy with light sedation
22F or 17F rigid scope with midazolam or propofol sedation for patients who prefer to be drowsy, or where access is difficult.
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Trigone-sparing injection technique
20 sites spread across the detrusor dome and lateral walls, sparing the trigone to reduce the risk of reflux and altered sensation.
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PTNS (percutaneous tibial nerve stimulation)
A non-invasive alternative: 30-minute weekly sessions for 12 weeks, then monthly maintenance. No retention risk, less durable, requires ongoing attendance.
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Sacral neuromodulation (InterStim)
An implanted device stimulating the S3 nerve root. Durable, works for both urgency incontinence and non-obstructive retention, but a surgical implant.
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Second-opinion review
A specialist review of your bladder diary, urodynamics and previous drug trials. Sometimes the answer is a different drug or PTNS, not another injection.
Our vetted London network
A small panel of London functional urologists, we picked them.
Consultants at University College London Hospital Private Urology, HCA The Wellington Urogynaecology, Cromwell BUPA, The London Clinic, Chelsea and Westminster Private and Guy's and St Thomas' Private. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every urologist in our network.
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Functional urologists and urogynaecologists with high intravesical-Botox case volumes
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CQC-registered private day-case units with cystoscopy facilities and nurse-led CISC teaching
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PTNS, sacral neuromodulation and Bulkamid pathways available when Botox is not the right call
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Anaesthetist-delivered sedation for patients who prefer not to be awake for cystoscopy
Safety and recovery
What to expect afterwards - honestly.
Intravesical Botox is a well-established day-case procedure. The things worth planning are UTI risk (15 to 20%), transient retention needing CISC, and giving the injection two to six weeks to take full effect before judging it.
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Transient urinary tract infection
Occurs in 15 to 20% after injection. Treated with a short antibiotic course. A urine dip on the day of injection reduces the risk.
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Urinary retention needing CISC
5 to 15% at 100 units, 20 to 30% at 200 units. Usually transient, lasting a few weeks. CISC is taught in clinic beforehand so it is a plan, not a surprise.
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Transient haematuria
A small amount of blood in the urine for 24 to 48 hours is common and settles on its own. Drink well and avoid strenuous exercise for a day.
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Bladder discomfort for 24 to 48 hours
A mild burning or urgency for a day or two after the injection is normal. Paracetamol and fluids usually cover it.
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No lasting effect on sensation
Botox blocks detrusor overactivity, not bladder sensation. You still feel when you need to void, just without the involuntary contractions.
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Contraindications
Active UTI, allergy to any botulinum toxin, myasthenia gravis or Lambert-Eaton syndrome, pregnancy or breastfeeding, and unwillingness to do CISC.
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Effect at 2 weeks, peak by 6
Symptoms improve gradually over the first fortnight and reach their peak by 6 weeks. Do not judge success in the first few days.
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Repeat every 6 to 9 months
Effect wears off gradually. Most patients rebook once urgency returns, typically at 6 to 9 months. No evidence of tachyphylaxis with repeat use.
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Red flags after discharge
Inability to void at all, fever with loin pain, heavy visible bleeding or clots - call the unit or attend A&E the same day.
Reading your procedure note
Your Botox note in four parts. Read the last one first.
Whichever unit and dose was used, the note the consultant sends you keeps to the same shape.
A quiet reminder
Urology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your 12-week review, just ask.
- 01 Header
Indication, dose and cystoscope used
Idiopathic OAB or neurogenic detrusor overactivity, dose in units (100 or 200), and whether flexible or rigid cystoscopy was used.
- 02 Technique
Injection map and volume
20 injections of 0.5 mL each into the detrusor, trigone spared. Any deviations from standard technique are noted here.
- 03 Findings
Bladder appearance and post-void residual
Trabeculation, diverticula or suspicious mucosal areas noted. Post-void residual on discharge, and whether CISC was started.
- 04 Impression
Follow-up plan and repeat interval
Read this first: when to expect effect (2 weeks), when to review (12 weeks), and the target interval for repeat (6 to 9 months).
Recognised by major UK insurers
Cover for intravesical Botox varies by insurer and by indication - usually funded when medically indicated after documented failure of two oral drugs. We confirm cover before booking.
Frequently asked
Everything we get asked about intravesical Botox.
Quick answers on CISC, insurance cover, repeat schedules, sedation, paediatric use and MS-related bladder dysfunction.
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Do I really need to learn self-catheterisation before Botox?
Yes. At the licensed 100-unit dose for idiopathic OAB, 5 to 15% of patients need clean intermittent self-catheterisation (CISC) for a few weeks after injection. At the 200-unit dose for neurogenic bladder, it is 20 to 30%. Learning CISC in clinic beforehand turns a potential emergency into a small inconvenience - and if you are unwilling to do it, intravesical Botox is not the right treatment.
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Will private insurance cover intravesical Botox?
Most major UK insurers (Bupa, AXA, Vitality, Aviva, WPA, Cigna) cover intravesical Botox when it is medically indicated - typically after documented failure of two antimuscarinics or an antimuscarinic plus mirabegron. Pre-authorisation is usually required. We confirm cover with your insurer before booking.
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How often do I need to repeat the injection?
Effect lasts 6 to 9 months for most patients. You rebook when urgency and frequency return - some patients feel it at 6 months, others go closer to 12. There is no evidence of reduced efficacy with repeat injections, so the schedule is symptom-driven, not calendar-driven.
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Is it done under sedation or a general anaesthetic?
Most patients have it under local anaesthetic gel alone via a flexible cystoscope - it takes 20 to 30 minutes and you can drive yourself home. Light sedation with midazolam is available if you prefer. A general anaesthetic is rarely needed for adults, though it is used for children and some neurogenic-bladder patients.
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Is Botox available for children with overactive bladder?
Intravesical onabotulinumtoxinA is licensed in the UK for children aged 5 and over with neurogenic detrusor overactivity, at a weight-adjusted dose. It is done under general anaesthetic in a paediatric urology unit, not as a private day-case in adults units. We refer to a specialist paediatric urologist.
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How does Botox work for MS-related bladder problems?
MS-related detrusor overactivity is one of the strongest indications for intravesical Botox. The 200-unit dose is NICE-approved and gives significant improvement in urgency incontinence for around 60 to 70% of patients, with a 6 to 9 month duration. Most MS patients are already comfortable with CISC, so the higher retention risk is manageable.
Ready when you are
Send us your bladder diary and referral - we come back within a working day.
A named London functional urologist, a firm quote across two or three units, and CISC teaching booked before your injection date.
Related treatments
Looking for something else?
-
PTNS for overactive bladder
Non-invasive weekly tibial-nerve stimulation for urgency and frequency.
Learn more -
Sacral neuromodulation (InterStim)
Implanted S3 stimulator for durable urgency and retention control.
Learn more -
Bulkamid urethral bulking
Injectable bulking for stress urinary incontinence.
Learn more -
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