Urinary retention rates after intravesical onabotulinumtoxinA injection for idiopathic overactive bladder in clinical practice and predictors of this outcome

Abstract

Aims The purpose of this study was to find the rate of urinary retention in clinical practice after treatment with onabotulinumtoxinA (BTN/A) for refractory overactive bladder (OAB) symptoms and determine factors that predict this outcome. Methods This is a retrospective study of BTN/A for treatment of non-neurogenic, refractory OAB symptoms. Patients were analyzed with respect to their first and second BTN/A injections. The primary outcome measure was postoperative urinary retention. Statistical significance was assessed with multivariate logistic regression. Results Based on inclusion and exclusion criteria, the study population was 160. Mean age was 64 ± 13.2 years and 24% of the patients were men. The rate of urinary retention was 35% (n = 56). For the first BTN/A treatment, multivariate analysis revealed that preoperative PVR (post-void residual volume) (OR 1.27, 95% CI 1.13–1.43, P < 0.001) and preoperative bladder capacity (OR 1.05, 95% CI 1.01–1.08, P = 0.005) were associated with postoperative urinary retention. In patients with a preoperative PVR of ≥100 ml, 94% (n = 17) went into urinary retention. For those who underwent a second BTN/A treatment, preoperative PVR, BTN/A units injected and retention after the first BTN/A were associated with an increased rate of postoperative retention. Conclusions Increased preoperative PVR was associated with urinary retention. The retention rate is higher than that reported in recent clinical trials. The inclusion of patients with a preoperative PVR ≥100 ml and a lower threshold to initiate clean intermittent catheterization contributed to this high rate of retention.

Very Low, Real-Time Rate of Urinary Retention after Intradetrusor Botox&lt;sup&gt;&amp;reg&lt;/sup&gt; for Non-Neurogenic Overactive Bladder

“…Osborn et al [5] recently reported an overall urinary retention rate of 35% in a clinical study consisting of patients with non-neurogenic OAB that were treated However our study does not support these findings. Despite having a high number of male patients (30%), only one patient in our study group required initiation of CIC yielding a urinary retention rate of 1.5%.…”

OnabotulinumtoxinA for the treatment of idiopathic overactive bladder is effective and safe for repeated use

“…13 Both phase 3 trials reported UTI as the most frequent adverse event, ranging from 15.5-20.4%, which is lower than the 26.6% rate observed in the de novo group of this study, and the 35% rate reported by Osborn et al These trials also reported rates of initiating self-catheterization of 6.1-6.9%, compared to 16.7% of the de novo group in this study. The trial reported by Chapple et al observed 3.6% of their trial arm had hematuria compared to 2% of the de novo group in this study.…”

“…Reflecting the real-world nature of this study, and similar to other such studies, 13 dosing for injections ranged from 100-200 U of OnabotA. While 100 U is the current recommended dose, 2 some patients in this study may have been initiated on 200 U before results from phase 3 trials were published and before OnabotA received Health Canada approval for the treatment of OAB with UI.…”

Past, Present and Future of Chemodenervation with Botulinum Toxin in the Treatment of Overactive Bladder

“…The frequency of adverse outcomes increases with higher and repeated doses of onaBoNT-A 15 . A recent retrospective study of onaBoNT-A treatment in non-neurogenic, refractory OAB patients found that rate of urinary retention was 35% 22 . Mean age of the 160 patients studied was 64 years, and 24% of the patients were men.…”