Long term safety outcomes and continuation rates of repeated Intravesical Botulinum Toxin A injections for Detrusor Overactivity: 16 year's experience of a Tertiary Centre in the UK

Introduction: Overactive bladder (OAB) affects 27% of women in the UK with an adverse impact on quality of life. Medical treatment with anticholinergics has a high discontinuation rate due to side effects. OnabotulinumtoxinA (BOTOX (R)) is an established treatment for refractory OAB, although there are little published data regarding safety with long term use. Objective: To report the long-term safety and continuation rates of intravesical Botox for OAB. Methods: This was a retrospective cohort study of patients treated with botulinum toxin A for OAB in a tertiary centre from 2007-2023. Data were collected retrospectively from medical records. Results: 132 patients were identified, with a total of 574 episodes of intravesical Botox. Mean age at first treatment was 55 years. After 1st Botox treatment, 21% of patients developed urinary tract infections. Clean intermittent self-catheterisation (CISC) was performed in 33% of patients, 5% of whom were performing CISC prior to treatment. The range of number of Botox treatments per patient was 1-18; 74% had more than one treatment. 52% of patients were lost to follow-up and 30% are ongoing patients. Recurrent UTIs developed in 23%. Conclusion: Repeated Botox injections appear to be a safe form of treatment for refractory OAB. Long term complications include recurrent UTIs, which affects 1 in 4 women, and voiding dysfunction, which affects 1 in 5. Only 1 in 3 women continue long term Botox treatment.