Kapur Anjali, Van Til Monica, Daignault-Newton Stephanie, Seibel Caitlin, Nagpal Shavy, Ippolito Giulia M, Smith Ariana L, Lucioni Alvaro, Lee Una, Suskind Anne, Anger Jennifer, Chung Doreen, Reynolds W Stuart, Cameron Anne P, Tenggardjaja Christopher, Padmanabhan Priya, Brucker Benjamin M
Department of Urology, New York University, Langone Health, New York, New York, USA.
Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
Neurourol Urodyn. 2025 Jun;44(5):1022-1030. doi: 10.1002/nau.70050. Epub 2025 Apr 14.
Onabotulinumtoxin A (BTX-A) is a minimally invasive therapy for idiopathic overactive bladder (iOAB). Incomplete bladder emptying is a known risk of the procedure, with an overall rate as high as 20% in male and female patients. Risk factors for incomplete bladder emptying after BTX-A have been reported in the literature, but are widely variable amongst studies and therefore patients at increased risk of this adverse effect cannot easily be identified by clinicians. The aim of this study was to evaluate whether pre-procedure urodynamics (UDS) findings are associated with incomplete bladder emptying after intradetrusor BTX-A injection for iOAB.
Data were analyzed from the SUFU Research Network (SURN) multi-institutional retrospective database. Men and women undergoing first-time injection of 100 units BTX-A for iOAB in 2016 were included. Subjects were excluded if they did not have record of pre-procedure and post-procedure (within 1 month) post-void residual volume (PVR). The primary outcome was incidence of urinary retention within 1 month after BTX-A, defined as PVR > 300 mL and/or initiation of self-catheterization or indwelling catheter. We assessed the association of pre-procedure UDS parameters with urinary retention using Wilcoxon rank tests, Fisher's exact test, and chi-squared tests.
A total of 167 subjects (141 women, 26 men) were included. Ninety-nine subjects (59%) had urodynamic data. Thirty-seven subjects (22%) had urinary retention within 1 month of BTX-A. There were no significant differences in age, gender, race, or body mass index between the retention and non-retention groups. There was no statistically significant difference in median Qmax between those who did and did not have postprocedure retention (10.0 vs. 14.3 mL/s respectively, p = 0.06). Mean PVR at the start of UDS was not statistically significant when comparing the retention and non-retention groups (22.5 vs. 10.0 mL respectively, p = 0.70). Bladder outlet obstruction index (BOOI), bladder contractility index (BCI), and presence of detrusor overactivity (DO) were not found to be associated with posttreatment retention.
This retrospective multi-institutional cohort study revealed that of patients who receive UDS before BTX-A, there are no significant UDS parameters or baseline demographic factors associated with incomplete bladder emptying after intradetrusor BTX-A injections for iOAB. Future studies that focus on better defining objective evidence-based predictors of incomplete emptying after BTX are needed to optimize patient perception of efficacy and satisfaction with this therapy.
A型肉毒毒素（BTX-A）是治疗特发性膀胱过度活动症（iOAB）的一种微创疗法。膀胱排空不全是该手术已知的风险，在男性和女性患者中的总体发生率高达20%。文献中已报道了BTX-A治疗后膀胱排空不全的风险因素，但各研究之间差异很大，因此临床医生难以轻易识别出发生这种不良反应风险增加的患者。本研究的目的是评估术前尿动力学（UDS）检查结果是否与iOAB患者行膀胱逼尿肌内注射BTX-A后膀胱排空不全相关。
对SUFU研究网络（SURN）多机构回顾性数据库中的数据进行分析。纳入2016年首次接受100单位BTX-A注射治疗iOAB的男性和女性患者。如果患者没有术前和术后（1个月内）排尿后残余尿量（PVR）的记录，则将其排除。主要结局是BTX-A治疗后1个月内尿潴留的发生率，定义为PVR>300 mL和/或开始自我导尿或留置导尿管。我们使用Wilcoxon秩和检验、Fisher精确检验和卡方检验评估术前UDS参数与尿潴留的相关性。
共纳入167名受试者（141名女性，26名男性）。99名受试者（59%）有尿动力学数据。37名受试者（22%）在BTX-A治疗后1个月内发生尿潴留。尿潴留组和非尿潴留组在年龄、性别、种族或体重指数方面无显著差异。术后发生尿潴留和未发生尿潴留的患者之间，最大尿流率（Qmax）中位数无统计学显著差异（分别为10.0 vs. 14.3 mL/s，p = 0.06）。比较尿潴留组和非尿潴留组时，UDS开始时的平均PVR无统计学显著差异（分别为22.5 vs. 10.0 mL，p = 0.70）。未发现膀胱出口梗阻指数（BOOI）、膀胱收缩力指数（BCI）和逼尿肌过度活动（DO）的存在与治疗后尿潴留相关。
这项回顾性多机构队列研究表明，在接受BTX-A治疗前接受UDS检查的患者中，没有显著的UDS参数或基线人口统计学因素与iOAB患者行膀胱逼尿肌内注射BTX-A后膀胱排空不全相关。未来需要开展研究，重点更好地定义基于客观证据的BTX治疗后排空不全的预测指标，以优化患者对该疗法疗效的认知和满意度。
