With the approval of your Family Dr. or Cardiologist please discontinue your blood thinner’s [aspirin, Eliquis, Coumadin, ibuprofen, Advil, Aleve etc.] no later than one week before your circumcision and for an additional three days past your steroid injection.  If you need pain control before or after your steroid you may use Tylenol, tramadol or the Norco’s we prescribed you.
 

Preoperatively Amy will be giving you two medication prescriptions. A. Levaquin 750 mg, once daily, #10 to help prevent urinary tract infections. B. Norco 10 mg #60, one to two every 4-6 hours for bladder pain and spasms.  Please fill these prescriptions prior to surgery so that on your day of surgery everything is set at home for your recuperation the day of surgery.  This is also to avoid last-minute pharmacy visits. Go straight home after surgery with your family member or friend and have them drive you home then at home to relax and begin healing. You cannot drive the day of surgery because a general anesthetic impairs your ability to interact with your environment promptly and effectively and may lead to injury to yourself, family or others.
 

At your Botox office visit Paula or Nicole will take you to our cystoscopy suite and will get you undressed and placed in a gown.  After you undress and slip into a gown they position you so lie down flat on you back.  Then place the bottoms of your feet up on the table and clean your urethra with betadine and then inject your urethra with a numbing agent called Lidocaine.  They will then take the Valium suppository that you bring with you to the office and place the Valium suppository into your rectum.  They will then give you a shot of Toradol [a pain medication] and let you rest for 20-30 minutes until you feel very relaxed. Once relaxed they will call me and we will start.
 

Paula and I will enter your room and I will start to talk to you and gauge how alert you are and if I agree that you are sleepy or very relaxed we will proceed with the procedure.  If not, we will give you another 10-15 minutes to optimize your anesthetic.  I will begin by telling you we are getting ready to start the procedure.  I place the thin flexible cystoscope into your urethra and if you want you can look at the injections as we perform them on the computer monitor to your left.  I will perform 20 injections [each with 5 units of Botox A the same type of Botox used for face wrinkles] and after the injections you may experience some mild pain but the Toradol will help with pain and some mild bleeding with urination will likely stop in two to three hours.  Please take your pain medication the Norco or Tylenol #4 Amy has given you and while at home relax for the remainder of the day and night.
 

The Botox does not work immediately it usually takes 7-10 days and will likely last from 6 to 9 months.  After your injection Amy will give you a follow-up appointment for 3 weeks because by then we will know if the therapy is working for you or not. My mother has been using Botox applied into her for more than 7 years and she doesn’t need to wear pads. She uses Botox because none of the available medications work for her, but I cannot guarantee that you will not need to wear pads but more than 50 % of our patients feel confident enough to go without pads.  The main benefit of Botox over all other medications is that it will not cause a dry mouth which leads to increase fluid intake and thus feeds the fire of needing to urinate all the time.
 

If after your Botox injection you have any problems or questions do not hesitate to contact Amy and she will relay your messages to me for a prompt answer.
 

Again, thank you for supporting our urology practice and remember we truly care to improve your urination.  I will seek every advancement in therapy as they come out, so you will always receive the most up to date therapy available.