Patel Devin N, Jamnagerwalla Juzar, Houman Justin, Anger Jennifer T, Eilber Karyn S
Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, 8635 West 3rd St, Suite 1070W, Los Angeles, CA, 90048, USA.
Int Urogynecol J. 2018 Jul;29(7):1005-1009. doi: 10.1007/s00192-017-3440-2. Epub 2017 Aug 14.
A known side effect of intravesical onabotulinumtoxinA (Botox®) injection for overactive bladder (OAB) is urinary retention requiring clean intermittent catheterization (CIC), the fear of which deters patients from choosing this therapy. In clinical practice, patients with an elevated postvoid residual (PVR) are often managed by observation only, providing they do not have subjective complaints or contraindications. We sought to determine the true rate of urinary retention requiring CIC in clinical practice.
A retrospective review was performed over a 3-year period of patients who received 100 units of intravesical onabotulinumtoxinA for the treatment of OAB. Patients were seen 2 weeks after the procedure to measure PVR. CIC was initiated in patients with a PVR ≥350 ml and in those with subjective voiding difficulty or acute retention.
A total of 187 injections were performed on 99 female patients. CIC was required following three injections (1.6%): for acute retention in two patients and subjective voiding difficulty in one patient with a PVR of 353 ml. Following 12 injections, the patient had a PVR of ≥350 ml, and following 29 injections, the patient had a PVR of >200 but <350 ml without symptoms. CIC was not initiated in these 41 patients. None of these patients experienced subsequent retention, and all showed resolution of their elevated PVR within 8 weeks.
In our series of 187 intravesical injections for OAB, the rate of postprocedure urinary retention requiring catheterization was only 1.6%. This low rate can be attributed to less rigorous criteria for CIC initiation than those applied in previous studies. While important to counsel patients on the risk of retention, patients can be reassured that the actual rate of CIC is low.
膀胱内注射A型肉毒毒素（保妥适®）治疗膀胱过度活动症（OAB）的一个已知副作用是尿潴留，需要进行清洁间歇性导尿（CIC），患者因担心这一点而不愿选择这种治疗方法。在临床实践中，对于排尿后残余尿量（PVR）升高的患者，只要没有主观不适或禁忌证，通常仅进行观察处理。我们试图确定临床实践中需要进行CIC的尿潴留的实际发生率。
对接受100单位膀胱内A型肉毒毒素治疗OAB的患者进行了为期3年的回顾性研究。术后2周对患者进行检查以测量PVR。对于PVR≥350ml以及有主观排尿困难或急性尿潴留的患者开始进行CIC。
共对99例女性患者进行了187次注射。3次注射后需要进行CIC（1.6%）：2例患者出现急性尿潴留，1例患者有主观排尿困难，其PVR为353ml。12次注射后，患者的PVR≥350ml，29次注射后，患者的PVR>200但<350ml且无症状。这41例患者未开始进行CIC。这些患者均未出现后续尿潴留，且所有患者的PVR升高情况在8周内均得到缓解。
在我们这组187次膀胱内注射治疗OAB的病例中，术后需要导尿的尿潴留发生率仅为1.6%。这一低发生率可归因于开始进行CIC的标准不如先前研究严格。虽然告知患者尿潴留风险很重要，但可以让患者放心，实际的CIC发生率很低。
