Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade After Approval: General...

Area of Science:

• Urology
• Anesthesiology
• Patient Experience

Background:

• OnabotulinumtoxinA detrusor injection (OnabotA DI) is an established treatment for idiopathic overactive bladder (iOAB) and neurogenic detrusor overactivity (nDO).
• The procedure is commonly performed under local anesthesia (LA), with ongoing efforts to minimize patient discomfort.
• Patient-reported anxiety and pain levels associated with LA versus general anesthesia (GA) for OnabotA DI have not been extensively compared.

Purpose of the Study:

• To compare anxiety and pain levels in patients undergoing OnabotA DI with either local anesthesia (LA) or general anesthesia (GA).
• To assess the impact of anesthesia choice on patient experience and treatment satisfaction.
• To evaluate differences in anxiety and pain between first-time and repeat OnabotA DI procedures.

Main Methods:

• A prospective study evaluating 104 patients scheduled for OnabotA DI, offering a choice between LA and GA.
• Anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS).
• Pain was measured using the Visual Analogue Scale (VAS) during and after the procedure; treatment success was evaluated with validated questionnaires.

Main Results:

• The General Anesthesia (GA) group reported significantly lower intraprocedural pain (VAS: 1.5 ± 1.5) compared to the Local Anesthesia (LA) group (VAS: 3.3 ± 2.2).
• Patients receiving their first OnabotA DI under LA reported higher preoperative anxiety compared to those undergoing GA.
• Anxiety scores decreased significantly for repeat injections under LA (p = 0.038), and there were no differences in treatment success between LA and GA groups.
• Despite higher initial anxiety and pain, patients receiving OnabotA DI under LA expressed a preference for LA over GA.

Conclusions:

• While the first OnabotA DI under LA may involve significant anxiety and pain compared to GA, subsequent procedures show reduced patient burden.
• Local anesthesia (LA) is favored by patients over general anesthesia (GA) for OnabotA DI, even with initial discomfort.
• The choice of anesthesia for OnabotA DI should consider patient preference and the potential for reduced anxiety in repeat procedures under LA.