To ascertain whether a poor response and adverse events (voiding dysfunction and urinary tract infection) were predictable for first time botulinum toxin-A (BTX-A) injections in a patient cohort of refractory idiopathic overactive bladder (OAB) with detrusor overactivity (DO).

Patients who received BTX-A injections for the first time between the dates of March 2004 to August 2017 were analysed in this single center study. Urogenital Distress Inventory short form (UDI-6) questionnaires were collected both pre- injection and post- injection prospectively. A poor response was defined as a decrease of less than 16.7 on the UDI-6 questionnaire. Additional information was gathered from patient records in a retrospective fashion. Predictors of poor response, voiding dysfunction and UTI were analysed with multivariate logistic regression analysis.

74 patients were analysed. The only predictor of poor response was male gender (OR,5.45; 95% CI 1.83-16.47; p=0.002). Lower maximum urinary flow rates (OR,0.91; 95% CI, 0.83-0.99; p=0.023), male gender (OR,5.14; 95% CI 1.41-18.72; p=0.013) and hysterectomy in females (OR,4.55; 95% CI, 1.09-18.87;p=0.038) were predictors of clean intermittent self catheterisation (CISC). There was an increased risk of UTIs in patients who performed CISC (OR,5.26; 95% CI 1.38-20.0;p-value=0.015).

Male gender was associated with a poor response to BTX-A injections and increased risk of CISC. Lower maximum urinary flow rates and women with hysterectomies were at increased risk of requiring CISC post- injection. Performing CISC was associated with increased risk of UTI. These factors could be helpful when counselling or selecting patients.

Urology. 2019 Oct 15 [Epub ahead of print]

Mohammad Abrar, Luke Stroman, Sachin Malde, Eskinder Solomon, Arun Sahai

Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK., Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK. Electronic address: .