BTX-A for overactive bladder tied to incomplete emptying and UTI risk: Study

USA: In a new study conducted by William Stuart Reynolds and team, it was found that incomplete emptying and urinary tract infection (UTI) were increased than earlier investigations in people who had Onabotulinumtoxin A (BTX-A) for overactive bladder (OAB). Men were especially vulnerable to inadequate emptying. The findings of this study were published in Neurourology and Urodynamics Journal on 12th January 2022.

Although  BTX-A is an effective treatment for OAB, patients may be put off by side effects. The goal of the study was to report real-world rates of incomplete emptying and urinary tract infection in men and women who had BTX-A for OAB.

For this study, in 2016, eleven clinical sites conducted a retrospective analysis of adults who received their first BTX-A injection (100 units) for idiopathic OAB. Post Void residual (PVR) > 150 ml, prior BTX-A, pelvic radiotherapy, or the need for pre-procedure catheterization were all excluded. At 6 months, the primary outcomes were incomplete emptying (clean intermittent catheterization [CIC] or PVR 300 ml without the need for CIC) and urinary tract infection (UTI) (symptoms with either positive culture or urinalysis or empiric treatment). Using univariate and multivariate models, we examined rates of incomplete emptying and UTI between and across sexes.

The results of this study stated as follow:

1. 278 patients (48 men and 230 women) met the eligibility requirements. The average age was 65.5 years (range: 24-95).

2. Incomplete emptying was seen in 35% of males and 17% of women.

3. Incomplete emptying was found to be 2.4 times more often in men than in women.

4. 17% of men and 23.5 percent of women experienced at least one UTI, with the majority occurring during the first month after injection.

5. A history of past UTI was the best predictor of UTI (OR: 4.2).

"Rates of incomplete emptying and UTI were higher than many previously published studies in this multicenter retrospective study," wrote the authors. "Men were at particular risk for incomplete emptying. Prior UTI was the primary risk factor for postprocedure UTI."

Reference:

Reynolds WS, Suskind AM, Anger JT, Brucker BM, Cameron AP, Chung DE, Daignault-Newton S, Lane GI, Lucioni A, Mourtzinos AP, Padmanabhan P, Reyblat PX, Smith AL, Tenggardjaja CF, Lee UJ; SUFU Research Network. Incomplete bladder emptying and urinary tract infections after botulinum toxin injection for overactive bladder: Multi-institutional collaboration from the SUFU research network. Neurourol Urodyn. 2022 Jan 12. doi:10.1002/nau.24871. Epub ahead of print. PMID: 35019167.