Examining the Effects of Intra-detrusor Botox at Time of HoLEP in Men With Overactive Bladder Symptoms

This study is investigating whether injecting Botox (onabotulinumtoxinA) into the bladder wall at the same time as a prostate surgery called HoLEP (Holmium Laser Enucleation of the Prostate) can reduce overactive bladder symptoms in men. HoLEP removes excess prostate tissue that blocks urine flow, but many patients also have overactive bladder symptoms — urgency, frequency, and nighttime urination — that persist even after successful prostate treatment. Adding a Botox injection during the same procedure could address both problems at once. Eligible participants are males between 18 and 89 years old who are already scheduled for HoLEP and have overactive bladder symptoms. You must be willing and able to sign consent and complete questionnaires. Men with Botox allergies, active urinary tract infections, prior pelvic radiation, bladder cancer history, or those undergoing additional simultaneous surgeries are excluded. Participants will be randomly assigned to receive either Botox or no Botox during their HoLEP procedure, and bladder symptoms will be tracked at follow-up visits. This is a smart, practical study: since the patient is already under anesthesia for prostate surgery, adding a Botox injection adds minimal burden while potentially eliminating the need for a separate procedure to treat overactive bladder.