New England Section of the American Urological Association
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Trends in Urinary Retention Requiring Catheterization Following OnabotulinumtoxinA Treatment for Non-Neurogenic Overactive Bladder
Shravya K. Sakunala, BS1, Esther L. Finney, MD2, Amanda L. Pomeroy, MS1, Daisy S. Chen, MS1, Arthur P. Mourtzinos, MD2, Lara S. MacLachlan, MD2.
1Tufts University School of Medicine, Boston, MA, USA, 2Lahey Hospital & Medical Center, Burlington, MA, USA.

Background: Intradetrusor onabotulinumtoxinA injections are an effective treatment for overactive bladder (OAB) and urinary incontinence. Clinical trial data have demonstrated that 6% of patients with non-neurogenic OAB develop postoperative retention. We sought to investigate risk factors and patterns of catheterization in non-neurogenic patients at our institution. Methods: We performed a single-institution retrospective chart review of patients who received onabotulinumtoxinA injections for non-neurogenic OAB between 2005 to 2021 by two fellowship trained urologists. We determined the rate of post-operative urinary retention requiring catheterization. Determination for catheterization was made by the discretion of the provider and not by a post-void residual (PVR) threshold. We also analyzed the demographic, medical history, and treatment data to determine predictive factors and trends in catheterization. Results: Of 168 patients who received intradetrusor onabotulinumtoxinA injections, 16 required postoperative catheterization (9.5%). Patients with a history of a midurethral, pubovaginal, retropubic, or transobturator sling were significantly more likely to require postoperative catheterization (43.8% vs 9.6%, p = 0.00128). Gender, history of urinary tract infection, and history of fecal incontinence, constipation, or irritable bowel syndrome were not significant predictors. For those patients with retention, 10 patients required catheterization for <16 weeks, 4 patients for 17-36 weeks, and 3 patients for >36 weeks (up to 75 weeks). Eight patients required a catheter at treatment 1, 4 patients at treatment 2, 1 patient at treatment 3, 2 patients at treatment 4, and 1 patient at treatment 5. Finally, of twelve patients where follow-up PVR was available, 2 had a PVR between 150 to 200 mL, 3 had a PVR between 200 to 300 mL, and 7 had a PVR between 300 to 400 mL. Conclusions: Nearly 1 in 10 non-neurogenic patients receiving onabotulinumtoxinA treatment required postoperative catheterization, a higher rate than what is reported in the current literature. A significant number of patients who had previous sling surgery required catheterization. While the majority of catheterization length was less than four months, some patients experienced prolonged catheterization alongside continued treatment. Further investigation is required to better understand risk factors for catheterization in non-neurogenic patients receiving onabotulinumtoxinA treatment for OAB.


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