TITLE:
Very Low, Real-Time Rate of Urinary Retention after Intradetrusor Botox® for Non-Neurogenic Overactive Bladder
AUTHORS:
Kirin K. Syed, Christopher S. Gomez, Angelo E. Gousse
KEYWORDS:
Intradetrusor OnabotulinumtoxinA, Refractory Non-Neurogenic Overactive Bladder, Urinary Retention, OAB, Urinary Retention Rate, Botox®
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.7 No.8,
August
21,
2017
ABSTRACT: Introduction: According to the most recent AUA/SUFU guidelines, intradetrusor
onabotulinumtoxinA (BTN/A) is a standard, evidence strength grade B, third line
treatment option for refractory non-neurogenic overactive bladder (OAB).
Urinary retention is the most common clinically significant reported side effect ranging from 5.4% to 43% in previous
studies. The aim of this study was to
investigate the real-time rate of urinary retention in patients treated with BTN/A for refractory
non-neurogenic OAB in a multi-institutional study. Methods: Retrospective chart review identified 71 patients who were treated with 100U
BTN/A for refractory non-neurogenic OAB from August 2011 to July 2015 at two
institutions. Using a flexible cystoscope, 100U Botox® reconstituted with 10 ml normal saline was administered. Injections of 1 ml (10 units/ mL)
were administered in 10 evenly distributed sites sparing the trigone. Pre and
post BTN/A post-void residuals (PVR) were reviewed. Urinary retention was defined as PVR > 200 mL requiring clean intermittent catheterization (CIC). Results: After exclusion, the study group consisted of 66
patients with a mean age of 67 years and 30% were men. Mean pre and
post-procedural PVR were 14.06 mL and 69.21 mL. Eight patients (12.12%) were noted to have elevated PVR > 200 mL post
injection however only one patient (female) required
initiation of CIC. The rate of
urinary retention was 1.5% (N = 1). There was no correlation with age, history of previous
radiation, diabetes or prior use of a neuromodulator device. Conclusions: To the best of our knowledge, this is the
first study to demonstrate a very low risk of real-time urinary retention rates in appropriately
selected patients treated with BTN/A for refractory non-neurogenic OAB
outside of a clinical trial setting.