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New England Section of the American Urological Association

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Incomplete bladder emptying and urinary tract infection after Onabotulinumtoxin A injection for overactive bladder in men and women: multi-institutional collaboration from the SUFU Research Network
Arthur Mourtzinos, MD,MBA.
Lahey Clinic Medical Center, Burlington, MA, USA.

Introduction:Despite onabotulinumtoxinA (BTX) being an effective third-line therapy for overactive bladder (OAB), incomplete bladder emptying (IBE) and urinary tract infections (UTI) are barriers for some patients. The objective of this study is to report real world 6-month rates of IBE and UTI in men and women undergoing first-time BTX injection for OAB and to identify potential risk factors for these outcomes.Methods: Eleven clinical sites performed an IRB-approved retrospective study of adult men and women undergoing first-time BTX injection (100 units) for non-neurogenic OAB between 1/1/2016 -12/31/16. Exclusions included: post void residual (PVR) >150ml, prior BTX or sacral neuromodulation, pelvic radiation, or catheterization. Clinical data were collected for prior 6 and subsequent 12 months from the index procedure. IBE was defined as the need for clean intermittent catheterization (CIC) or a post-procedure PVR  300 ml without the need for CIC and UTI as whether a URI was indicated as present in the medical record, including whether antibiotics were initiated for UTI, there was a positive culture or UA, and UTI symptoms within 6 months after injection. We compared rates of primary outcomes (IBE and UTI) between sex and individually by sex, using univariate and multivariable models including our primary exposure variables.Results: 278 patients (48 men and 230 women) met inclusion criteria. Mean age was 65.5 (range 24-95), 13% had history of UTI. Outcomes of CIC, PVR300mL, IBE, and UTI by sex are summarized in Table 1. In multivariable analysis, male sex was associated with 2.4 (CI (1.04-5.49) higher odds of IBE than female sex. For UTI, 8(17%) men and 54 (23.5%) women had 1 UTI within 6 months (p=0.30), the majority within the first month following injection. The strongest predictor of UTI was history of prior UTI with odds 4.2 (95% CI: 1.7-10.3) higher compared to lack of UTI history. Conclusions: Real world rates of IBE and UTI were higher than many previously published studies in this multicenter retrospective study. Males were at particular risk for IBE, and prior UTI was the primary risk for post-procedure UTI. Other clinically significant predictive factors were not identified in this multicenter cohort. Table 1. Summary of outcomes within 6 months by sex

Outcomes within 6 monthsMale (N=48)Female (N=230)p-value
CIC13 (27%)32 (14%)0.024
PVR300mL11 (25%)25 (12%)0.024
IBE17 (35%)39 (17%)0.004
UTI8 (17%)54 (23.5%)0.30


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