Intravesical Botulinum Toxin Type A for an Overactive Bladder: A Single-Center Audit

Area of Science:

• Urology
• Pharmacology
• Clinical Medicine

Background:

• Intravesical botulinum toxin type A (BoNT-A) is a key third-line treatment for refractory overactive bladder (OAB).
• Real-world outcome audits are crucial for understanding BoNT-A therapy across diverse patient groups.
• This study audits BoNT-A outcomes in a heterogeneous patient population at a teaching hospital.

Purpose of the Study:

• To assess the clinical outcomes of intravesical BoNT-A therapy in patients with refractory overactive bladder (OAB).
• To evaluate efficacy, safety, and specific patient subgroup outcomes, including catheterization needs and adverse events.

Main Methods:

• Retrospective audit of 193 patients receiving intravesical BoNT-A for OAB (Jan-Dec 2024).
• Inclusion criteria: confirmed OAB diagnosis via urodynamic testing and multidisciplinary team approval.
• Systematic analysis of demographic data, treatment parameters, efficacy, adverse events, and catheterization requirements; statistical analysis using chi-square and Fisher's exact tests.

Main Results:

• Treatment success observed in 82.4% of patients; median duration of effect was 6 months.
• Common indications included idiopathic detrusor overactivity (77.2%) and neurogenic detrusor overactivity (21.2%).
• Urinary tract infection (UTI) rate was 4.7%; NDO patients (53.7%) were more likely to require post-treatment catheterization.

Conclusions:

• Intravesical BoNT-A is effective and safe for refractory OAB management, providing sustained benefits requiring repeat treatments.
• Diabetic patients may face a slightly elevated UTI risk, and NDO patients have higher catheterization needs.
• BoNT-A is a valuable OAB treatment option, emphasizing the importance of patient selection and counseling.