Using intravesical botulinum toxin as an adjunct during urologic surgery: a systematic review

Intravesical onabotulinum toxin-A (BTX-A) has been studied as a curative therapy for overactive bladder (OAB), neurogenic bladder, and interstitial cystitis. Limited evidence supports adjunctive BTX-A during urologic surgeries to reduce bladder spasms and improve outcomes. This study examines the role of adjunctive BTX-A at the time of urologic surgery.

A literature search of four databases (MEDLINE, Embase, Cochrane Library, and Web of Science) was performed for studies describing adjunctive BTX-A during urologic surgery and its impact primarily on quality of life and urinary outcomes. Studies investigating BTX-A as a curative therapy or in the post-operative setting were excluded.

Literature search identified 2175 studies. Thirteen studies were included. Three studies investigated BTX-A at the time of benign prostatic hyperplasia surgery. All studies found that combination therapy led to improved patient-reported continence scores. Seven studies investigated BTX-A at the time of mid-urethral sling to treat urgency incontinence (UI) in patients with mixed incontinence. Five of seven studies found that combination therapy led to improved OAB and UI symptom scores. Two studies explored BTX-A at the time of bladder reconstruction and found that BTX-A reduced postoperative pain and improved lower urinary tract symptoms. One study found that pre-operative BTX-A use before vesicovaginal fistula repair reduced bladder spasms. No studies found a significantly increased risk of urinary retention with adjunctive BTX-A.

Initial evidence supports the use of BTX-A at the time of urologic surgeries to decrease bladder spasms and improve post-operative pain and continence without increasing the risk of urinary retention. Further study is required to understand its optimal role and indication.