Safety of Intradetrusor OnabotulinumtoxinA (BTX-A) Injection in the Asymptomatic Patient With a Positive Urine Dip

Impact of Duration of Antibiotic Prophylaxis on Incidence of UTI after OnabotulinumtoxinA Injection

OBJECTIVE

To assess the impact of duration of antibiotic prophylaxis on incidence of UTI after intravesical OnabotulinumtoxinA (BTX) injection.

METHODS

A retrospective cohort study of patients with overactive bladder (OAB) who underwent office BTX injections from 2014-2020. UTI incidence within 30 days of BTX was compared between three durations of antibiotic prophylaxis: no antibiotic, single day, or multiple day course. Association of UTI with units of BTX, BMI, history of diabetes, immunosuppression, neurogenic OAB, chronic catheter, or recurrent UTI were investigated.

RESULTS

290 patients and 896 cycles of BTX injections were included: 877 injections (97.7%) were women, with mean age 61.4 years (range 20-96; SD 13.3). No antibiotic prophylaxis was given to 112 (12.5%) patients, 595 (66%) received a single day, and 189 (21%) received a multiple day regimen (3-7 days). Overall incidence of UTI within 30 days was 11.4%. On multivariable logistic regression, use of any antibiotic prophylaxis was associated with a lower incidence of UTI (single OR 0.34; 95% CI 0.19-0.61; p<0.001; multiple OR 0.47; 95% CI 0.24-0.92; p=0.029), with no difference between single and multiple day regimens (OR 1.38; 95% CI 0.80-2.38; p=0.249). History of recurrent UTI (OR 3.77; 95% CI 2.23-6.39; p<0.001) and chronic suprapubic catheter (OR 2.88; 95% CI 1.04-7.95; p=0.041) were additional predictors.

CONCLUSION

A multiple day regimen of antibiotic prophylaxis was not more effective than a single day in preventing UTI for intravesical BTX injection. Use of any antibiotic prophylaxis was associated with a significantly lower incidence of UTI compared to no antibiotic.

Telemedicine follow-up is safe and efficacious for synthetic midurethral slings: a randomized, multi-institutional control trial

Introduction and hypothesis

The objective was to assess whether telemedicine-based follow-up is equivalent to office-based follow-up in the early postoperative period after routine synthetic midurethral sling placement.

Methods

This is a prospective, international, multi-institutional, randomized controlled trial. Patients undergoing synthetic midurethral sling placement were randomized to 3-week postoperative telemedicine versus office-based follow-up. The primary outcome was the rate of unplanned events. Secondary outcomes included patient satisfaction, crossover from telemedicine to office-based follow-up, and compliance with 3- to 5-month office follow-up.

Results

We included 238 patients (telemedicine: 121 vs office: 117). No differences in demographics or medical comorbidities were noted between the study groups (p = 0.09–1.0). No differences were noted in unplanned events: hospital admission, emergency department visit, or unplanned office visit or call (14% vs 12.9%, p = 0.85) or complications (9.9% vs 8.6%, p = 0.82). Both groups were equally “very satisfied” with their surgical outcomes (71.1% vs 69%, p = 0.2). Telemedicine patients were more compliant with 3- to 5-month office follow-up (90.1% vs 79.3%, p = 0.04).

Conclusions

After synthetic midurethral sling placement, telemedicine follow-up is a safe patient communication option in the early postoperative period. Telemedicine patients reported no difference in satisfaction compared with office-based follow-up but had greater compliance with 3- to 5-month follow-up.

Routine Office Assessment After OnabotulinumtoxinA Injection for Overactive Bladder Is Unnecessary to Detect Clinically Significant Voiding Dysfunction

OBJECTIVE

This study aimed to determine if routine assessment of patients after onabotulinumtoxinA injections for overactive bladder is necessary to detect clinically significant voiding dysfunction.

METHODS

This retrospective cross-sectional cohort study analyzed patients who underwent intravesical injection of onabotulinumtoxinA for overactive bladder during a 4-year period. Patients were included for analysis if they returned for an office follow-up visit within 1 month of administration. Baseline demographic data; procedural details; postvoid residual volumes; abnormal postprocedure voiding symptoms, including urinary frequency, pain, or inability to void; urinary tract infections; and initiation of intermittent self-catheterization were recorded. Descriptive statistics, point-biserial and Pearson correlation analyses were performed.

RESULTS

Two hundred thirty-seven injections were included in our analysis. Fifteen encounters, from 13 patients, required the initiation of intermittent self-catheterization (6.3%). The median postvoid residual in those treated with intermittent self-catheterization was 300 mL (min, max: 200, 750 mL); all had received 100 units of onabotulinumtoxinA. The most common symptom among those requiring intermittent self-catheterization was urgency (n = 13; 87%), whereas 93% (n = 14) had at least 1 bothersome symptom. Correlation analyses showed a weak positive correlation with elevated postvoid residual volume and a history of prolapse repair (r = 0.269, P = 0.004), and prior pelvic surgery (r = 0.205, P = 0.029).

CONCLUSIONS

Clinically relevant urinary retention that required intermittent self-catheterization after onabotulinumtoxinA injection for overactive bladder occurred in 6.3% of participants in this sample. The vast majority of patients who required intermittent self-catheterization described symptoms that they were able to self-identify.