Introduction: OnabotulinumtoxinA (BTX) is an effective third-line therapy for overactive bladder (OAB), however the potential for adverse events may prevent patients from initiating therapy. The objective of this study is to report rates of incomplete emptying and urinary tract infection (UTI) in men and women undergoing BTX for OAB and to identify potential risk factors for these adverse events. Methods: Eleven clinical sites performed an IRBapproved retrospective study of adult women and men undergoing first-time BTX injection (100 units) for non-neurogenic OAB in 2016. Exclusions included: post void residual (PVR) >150ml, prior BTX, pelvic radiation, or catheterization. Clinical data was collected 6 months before the index procedure. Incomplete emptying was defined as the need for clean intermittent catheterization (CIC) or a post-procedure PVR≥300 ml without the need for CIC within 6 months of the BTX. UTI was defined as symptoms combined with either positive culture or urinalysis or empiric treatment up to 6 months after BTX. We compared rates of incomplete emptying and UTI between sex and individually by sex, using univariate and multivariable models. Results: 278 patients (48 men and 230 women) met inclusion criteria. Mean age was 65.5 (range 24-95), 13% had history of prior UTI. Within the 6 months after treatment, 35% of men and 17% of women had incomplete emptying and 17% of men and 24% of women had UTI. Outcomes of CIC, PVR≥300mL, incomplete emptying, and UTI by sex are summarized in Table 1. In multivariable analysis, men were associated with 2.4 (95% CI 1.04-5.49) higher odds of incomplete emptying than women. For UTI, 8 (17%) men and 54 (23.5%) women had ≥1 UTI (p=0.30), the majority of which occurred within the first month following injection. The strongest predictor of UTI was history of prior UTI compared to those without (OR 4.2 [95% CI 1.7-10.3]). Conclusion: In this multicenter retrospective study rates of incomplete emptying and UTI were higher than many previously published studies. Men were at particular risk for incomplete emptying. Prior UTI was the primary risk factor for post-procedure UTI. Other clinically significant predictive factors were not identified in this multicenter cohort.
Reynolds WS, Suskind AM, Anger JT, Brucker BM, Pelletier Cameron A, et al. Incomplete bladder emptying and urinary tract infections after onabotulinumtoxinA injection for overactive bladder in men and women: multi-instutional collaboration from the SUFU research network. Paper presented at: The Annual Winter Meeting of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction; 2021 Feb 25-27; Virtual. Available at: https://sufuorg.com/docs/meetings/sufu2102/program-book-abstracts.aspx