Patients with prior prostate surgery have a lower probability of requiring catheterization after intravesical onabotulinum toxin-A injections (BoNT-A) for idiopathic overactive bladder (OAB) than surgery-naïve patients, according to new findings published in European Urology Focus.
In a retrospective study of 477 men treated with intravesical onabotulinum toxin-A for refractory OAB, rates of discontinuation were not significantly different among men with no prior prostate surgery, prior transurethral resection of the prostate (TURP), and prior radical prostatectomy (RP): 75%, 70.0%, and 62.5%, respectively. Satisfaction with intravesical onabotulinum toxin-A treatment also was comparable: 28.6%, 39.3%, and 33.3%, respectively.
All patients who underwent prior RP had wet OAB compared with 71% of nonsurgery patients and 85% for TURP patients. Nonsurgery patients, however, had significantly higher postvoid residual volume after onabotulinum toxin-A treatment compared with TURP and RP patients (mean 183, 63, and 36 mL, respectively), and significantly more of them required de novo clean intermittent self-catheterization (CISC): 28.6%, 7.5%, and 4.2%, respectively, Julia Bels, MS, of Maastricht University Medical Center in Maastricht, The Netherlands, and colleagues reported. Surgery-naïve patients had significant 4.9- and 9.2-fold increased odds of de novo CISC than TURP and RP patients, respectively. Prior catheter use and median dose of onabotulinum toxin-A were similar among groups and did appear to affect results.
The rate of bladder outlet obstruction differed among the 3 subgroups, however, and was highest among men without prior surgery (50%, 6%, and 26%, respectively), Bels’ team reported.
This finding highlights the importance of measuring bladder outlet obstruction prior to onabotulinum toxin-A treatment minimize the likelihood of de novo CISC.
Bels J, de Vries P, de Beij J, Marcelissen T, van Koeveringe G, Rademakers K. Long-term follow-up of intravesical onabotulinum toxin-A injections in male patients with idiopathic overactive bladder: comparing surgery-naïve patients and patients after prostate surgery. Eur Urol Focus. doi:10.1016/j.euf.2020.08.015