Skip to main content

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.

A stethoscope on a clinical desk

Indicative pricing

What private intravesical Botox costs in London.

Indicative ranges across London private units.

In short

Intravesical Botox in London, all-inclusive: £2,800 to £4,500, home the same day.

Procedure Indicative range
Consultant urology assessment and bladder diary review £250 to £450
Urodynamic studies (if indicated) £750 to £1,400
Intravesical Botox 100 units (idiopathic OAB) £2,800 to £3,800
Intravesical Botox 200 units (neurogenic detrusor) £3,500 to £4,500
CISC teaching session (nurse-led) £120 to £220
Repeat injection (6 to 9 months later) £2,800 to £4,500

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.

  • 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.

  • Worried about retention?

    Retention needing CISC affects 5 to 15% of idiopathic cases. Learn CISC in clinic beforehand and it stops being an emergency.

  • 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.

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.

  • Idiopathic overactive bladder, refractory

    Urgency, frequency and urge incontinence that has not responded to at least two antimuscarinics, or an antimuscarinic plus mirabegron.

  • Neurogenic detrusor overactivity in MS

    Multiple sclerosis with proven detrusor overactivity on urodynamics, causing incontinence or upper-tract risk. NICE-approved, 200-unit dose.

  • 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.

  • Antimuscarinic intolerance

    Dry mouth, constipation, blurred vision or cognitive fog on antimuscarinics, with ongoing symptoms despite mirabegron.

  • 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.

  • Not suitable: active UTI

    An untreated urinary tract infection is a contraindication. Dipstick and treat before rebooking, otherwise injection is postponed.

  • 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.

  • 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.

  • 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%.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • Contraindications

    Active UTI, allergy to any botulinum toxin, myasthenia gravis or Lambert-Eaton syndrome, pregnancy or breastfeeding, and unwillingness to do CISC.

  • 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.

  • 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.

  • 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 London consultant urologist reviewing a bladder-Botox procedure note

A quiet reminder

Urology language is precise and can read coldly - ask for it to be translated.

If you would like the note explained before your 12-week review, ask your urologist or GP.

  1. 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.

  2. 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.

  3. 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.

  4. 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

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for intravesical Botox varies by insurer and by indication - usually funded when medically indicated after documented failure of two oral drugs.

Frequently asked

Common questions about intravesical Botox.

Quick answers on CISC, insurance cover, repeat schedules, sedation, paediatric use and MS-related bladder dysfunction.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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. Referral to a specialist paediatric urologist is appropriate.

  • 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.

Related treatments

Looking for something else?