Urgent Matters

Eliminate urinary symptoms using BOTOX® therapy.

Two years ago, retired nurse Anna Marie Borchardt and her husband of 43 years relocated to Florida to escape the winter weather in Cincinnati, Ohio. The Kansas native gave birth to five
children, who produced seven grandchildren, whom she adores. She loves her children as well, but five pregnancies left her with a frustrating problem.

Dr. Alejandro Miranda-Sousa treated Anna Marie Borchardt for urinary frequency, urgency and incontinence with BOTOX® therapy. His practice, Urology Experts, has offices in Fort Myers, Cape Coral and Bonita Springs.

Anna Marie gets ready to take Max for a long walk.

“Having five children is really hard on a woman’s bladder,” she confides. “I suffered with an urgency to urinate. No matter where I went, the first thing I had to do was look for a bathroom. As soon as I thought I had to go to the bathroom, I had to get there. It was so aggravating, and it was a nuisance.

“I woke up two or three times at night, and it was embarrassing when I went out with friends. As soon as I sat down, I had to get up and go to the bathroom. If I went to a baseball game, first I had to find a bathroom. At church, I had to get up during Mass. I had to wear pads when I went to exercise and when I took my dog Max for his walks.”

To treat her urinary urgency and its related frequency and incontinence, Anna Marie tried several conservative methods. She followed the recommendations of her primary care provider, including performing the specialized Kegel exercises for strengthening the muscles of the pelvic floor to reduce leakage from her overactive bladder.

“I did the exercises,” she states. “I even tried taking pills so I wouldn’t have to urinate as often. But the medication wasn’t for me. It dried out my mouth, made me thirsty all the time and was very expensive. I told myself this had to stop.

“One day, I was talking about my condition to my sister, who had six kids. I knew she suffered with the same problems, but she said, Why don’t you try BOTOX® therapy? She explained the therapy to me and how it’s done. She said it changed her life.”

After speaking with her sister, Anna Marie took to the internet. She looked for providers in the area who not only offered BOTOX therapy but were also highly rated. Her search led her to Alejandro Miranda-Sousa, MD, of Urology Experts in Fort Myers.

“I went online to see how many stars the doctors had by their names,” she relates. “God’s hand was on my shoulder when I picked Dr. Miranda-Sousa. Dr. Miranda-Sousa did all the necessary tests, scheduled the treatment, then performed the procedure.”

Relaxing Muscles

“Anna Marie presented with symptoms of urinary frequency and urgency, or the intense feeling of having to go to the bathroom,” reports Dr. Miranda-Sousa. “She also had urge incontinence, which is leakage when the urge is strong and she doesn’t get to the bathroom right away. She also complained of nocturia, awakening in the middle of the night to urinate.

“She made behavioral modifications such as changing her diet and lifestyle habits, and she tried multiple medications without any major improvement. I performed a urodynamic study and confirmed that her bladder muscle was having multiple spasms. At that point, we discussed the next line of treatments, including BOTOX therapy.”

BOTOX is a powerful neurotoxin that blocks the contraction of muscle tissue, explains Dr. Miranda-Sousa.

“Over the past twenty years, BOTOX was FDA-approved for a variety of medical applications,” informs the doctor. “It is used to treat conditions that involve muscle contraction such as migraines and muscle spasms.

“It is also a common tool for cosmetic intervention, used mainly to smoothen wrinkles on the forehead and neck or near the eyes and nose. The idea is to inject the BOTOX directly into the muscle that is contracted and relax it, which softens the line or wrinkle it formed.”

Three years ago, BOTOX was FDA-approved for another use, injection into the urinary bladder muscle to temporarily paralyze it. This relieves the symptoms of urgency, frequency, urge incontinence and nocturia that result from the muscle spasms of overactive bladder. 

“BOTOX therapy is safe and effective, but not a first-line treatment,” observes Dr. Miranda-Sousa. “It is used primarily when patients have tried conservative treatments, such as behavioral modification, fluid management, Kegel exercises and medications, and haven’t responded to them.

“Patients who get this therapy typically improve significantly within four weeks of the treatment, sometimes as quickly as one week. The improvement generally lasts from four to eight months, at which time the therapy can be repeated. Usually, the results of subsequent treatments last longer than those of the initial therapy.”

In most cases, BOTOX therapy is provided in the office at Urology Experts. It takes approximately ten minutes to complete and is relatively painless. Patients might feel a little pinch, but no real discomfort.

“We inject the BOTOX into the bladder muscle via a cystoscope through the urethra, the tube that carries urine from the bladder out of the body,” describes Dr. Miranda-Sousa. “The cystoscope is a slim tube with a light and camera at its end. It enables us to have direct vision of the bladder while we do the injection.”

“When Dr. Miranda-Sousa was doing the BOTOX therapy, I had to lie down with my feet in stirrups, like I was having a baby,” comments Anna Marie. “He simply inserted a tube into my urethra and injected the BOTOX, and that was it.”

Miracle Worker

When Dr. Miranda-Sousa recommended the BOTOX therapy Anna Marie’s sister told her about, Anna Marie felt hopeful the treatment might provide her with some relief from her annoying bladder symptoms. When the treatment was completed, Anna Marie was pleasantly surprised to discover how well and how quickly the therapy worked for her.

“I couldn’t have asked for a better doctor.” – Anna Marie

“It’s been a miracle,” she marvels. “BOTOX therapy has made a huge difference in my urgency, frequency and leakage, and it didn’t take long to feel its effects.

“About two weeks after Dr. Miranda-Sousa did the injection, I could really see a change. I wasn’t running to the bathroom like a crazy woman. I didn’t have to wear pads when I exercised or took Max for his walks. Just like it was for my sister, BOTOX therapy was life-changing for me.”

Now that Anna Marie’s frustrating bladder symptoms are gone, she’s not shy about singing the praises of Dr. Miranda-Sousa and Urology Experts. She rates her overall experience with them as “excellent.”

“I couldn’t have asked for a better doctor,” she enthuses. “It was the hand of God that found him. Dr. Miranda-Sousa is the neatest guy. He’s very nice and caring. He definitely knows what he’s doing; he’s a very good doctor. He explains everything to me. We just click.

“Dr. Miranda-Sousa is a very busy man, and his office is always full. That just shows you how good he is. But he always takes his time with me and answers any questions I have. I’ve never been rushed out of his office.

“His staff are really nice people, too, and they’re hard workers. I really enjoy them. I highly recommend Dr. Miranda-Sousa and Urology Experts, as well as the BOTOX therapy. They can change your life.”

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    • Urology Experts

      The team at Urology Experts is dedicated to providing exceptional healthcare and personalized treatment plans. They offer a number of different urological services and specialties that will help any patient restore their quality of life.... Read More

    • Alejandro Miranda-Sousa, MD

      Alejandro Miranda-Sousa, MD, is a board-certified urologist by the American Board of Urology. Dr. Miranda-Sousa graduated from the prestigious Universidad Peruana Cayetano Heredia School of Medicine in Lima, Peru. He also completed his r... Read More