Intradetrusor injection of onabotulinumtoxinA (BTX-A) is safe and effective for the treatment of overactive bladder (OAB) in elderly patients, according to data presented at the International Continence Society’s 2022 annual meeting (ICS 2022) in Vienna, Austria.

Natalia Hernandez, MD, of Houston Methodist Hospital in Texas, and colleagues retrospectively studied 141 patients older than 70 years (124 [88%] women) who received intradetrusor BTX-A injections. Prior to treatment, 132 patients (94%) were voiding spontaneously. Urinary urgency was the most common symptom, occurring in 97.3% of patients, followed by urinary incontinence and daytime frequency in 93% and 85%, respectively.

The most common medications initially prescribed were an anticholinergic (74%) and beta-3 agonists (19%). With respect to doses of BTX-A, 89% and 6% received injections of 100 U and 200 U, respectively.

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The researchers found that 73%, 77%, 72.5%, and 68% reported improvement in incontinence, urinary urgency, daytime urinary frequency, and nighttime frequency, respectively, Dr Hernandez reported.

The investigators also performed a subgroup analysis of 26 patients older than 80 years (22 [85%] female). Initially prescribed medications included anticholinergics (50%) and beta-3 agonists (38%). The most common reason for receiving BTX-A was no response to oral medications. Of the 26 patients, 81% and 73% of patients reported a marked improvement in urinary urgency and urinary incontinence, respectively. The investigators observed symptomatic urinary tract infection in 3 patients (12%).

Dr Hernandez’s team noted that oral anticholinergics and beta-3 agonists have been linked, respectively, to negative cognitive effects and to possible adverse effects on blood pressure.

“BTX-A is well tolerated in patients older than 70 years with significant improvement in all OAB symptom domains and significant reduction of their oral OAB medication needs,” the authors wrote. “This provides an option for patients to limit oral medications with unwanted side effects for this special population potentially at an earlier time in the OAB management algorithm.”


Hernandez N, Stading R, Miceli L, et al. Outcomes of intradetrusor injection of onabotulinumtoxinA (BTX-A) for overactive bladder in the elderly population. Presented at: ICS 2022; September 7-10, Vienna, Austria. Abstract 165.