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Objective: The objective of this article is to determine treatment outcomes and risk factors for urinary retention in men with idiopathic overactive bladder (OAB) symptoms treated with intravesical botulinum toxin A (BTXA). Patients and methods: All men undergoing intravesical BTXA treatment from 2009 to 2013 at the Royal Berkshire Hospital were identified. Pre-treatment urodynamics and outcomes of treatment were determined. Results: A total of 35/43 men were deemed to have idiopathic OAB. Symptomatic improvement was seen in six of 13 (46%) dry OAB and 12/22 (55%) wet OAB irrespective of proven detrusor overactivity. Catheterisation rates were dose dependent with an overall rate of 16/35 (46%). Four of nine (44%) with bladder outflow obstruction required catheterisation, as did eight of 17 (47%) without. Twelve of 25 (48%) men with a Bladder Contractility Index (BCI) ⩽120 required catheterisation, as did four of 10 (40%) with a BCI >120. Conclusion: BTXA is a successful treatment in males with idiopathic wet and dry OAB, irrespective of detrusor overactivity. One hundred units is an appropriate dose at which to begin treatment. Surprisingly, presence of bladder outflow obstruction and weak bladder contractility did not demonstrate an increased risk for catheterisation although further study should be conducted with larger numbers of patients.

Objectives To investigate the risks and long‐term outcomes of suprapubic catheter (SPC) insertion in a population predominantly with spinal cord injury. Materials and Methods We used the theatre database at the National Spinal Injuries Centre in Stoke Mandeville Hospital to identify 1000 consecutive SPC insertions from 1998 to 2015. We retrospectively analysed all records for these patients. Results Follow‐up ranged from 4 weeks to 16.45 years (median 3.3 years). Either cystoscopy‐guided suprapubic puncture (Lawrence Add‐a‐Cath trochar) or a direct incision onto a urethral sound (Lowsley retractor) followed by cystoscopy was used for 98% of insertions. Complications graded as Clavien–Dindo IIIb or higher occurred in 0.6% of patients. Return to theatre was necessary in 0.4%, including three laparotomies due to bleeding or misplacement of the catheter, but no bowel injuries occurred. One death occurred within 30 days due to pulmonary embolism. There were no significant differences in outcomes between insertion methods. Tolerance of long‐term suprapubic catheterisation was high, despite 59% of cases experiencing mostly minor complications. Tract losses during routine community change and variability in antibiotic prescribing highlighted areas for educational development which could improve patient outcomes. Conclusions This study supports the view that the risk of major complications from SPC insertion is lower than previously reported. Minor complications related to the catheter are common in the long term but are generally well tolerated.

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