EARLY OUTCOMES OF REFRACTORY OVERACTIVE BLADDER TREATED WITH BOTULINUM TOXIN IN A FEMALE UROLOGY CLINIC

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(Purpose) To evaluate the safety and efficacy of outpatient procedures using botulinum toxin (BTX) for patients with intractable overactive bladder (OAB) in a Female Urology Clinic. (Methods) Medical charts of female patients who underwent outpatient BTX procedures for intractable OAB were retrospectively reviewed between 2020 and 2022. In addition to uroflowmetry and residual urine measurement, OAB symptoms score (OABSS), international prostate symptom score (IPSS), and patient global impression of improvement (PGI-I) were evaluated preoperatively and postoperatively at 2, 6, 12, and 24 weeks. (Results) Forty-one patients underwent a total of 50 BTX procedures during the above period (1 procedure: 34 patients, 2 procedures: 5 patients, 3 procedures: 2 patients). The average age was 72.4±7.6 (50-86), and 9 (22.0%) and 3 (12.2%) patients had a history of surgeries for pelvic organ prolapse and stress urinary incontinence, respectively. Two patients (4.9%) developed temporal urinary retention which was managed with clean self-intermittent catheterization. Symptomatic urinary tract infection occurred in 3 patients (7.3%). The average maximum flow rate showed a small but significant decrease, and the average residual urine significantly increased from preoperative 41.4 ml to 103.4 ml (week 2), 88.5 ml (week 6), 72.4 ml (week 12), and 60.3 ml (week 24). However, IPSS-voiding symptom score did not show significant differences at week 2-24. OABSS-Q1 (daytime frequency) did not show significant improvement at any point, and OABSS-Q2 (nocturnal frequency) showed significant improvement at week 2 and 6. OABSS-Q3 (urinary urgency), OABSS-Q4 (urgency urinary incontinence), OABSS total score, IPSS-Q4 (urinary urgency), IPSS-storage symptom score, and IPSS-QOL all showed significant improvement at week 2-24. PGI-I showed the highest improvement rates at week 2 (marked improvement 63.4%, improvement 92.7%), and this improvement was sustained at week 12 (marked improvement 43.6%, improvement 84.6%). Most patients did not choose to have additional therapy until 24 weeks to over one year had passed. Furthermore, 12 patients (29.3%) chose to have a second BTX procedure. (Conclusion) In Female Urology Clinics, there are many patients suffering from refractory OAB including those after surgeries for pelvic organ prolapse and stress urinary incontinence. As urinary retention is less frequently caused by BTX and its efficacy is more evident among female patients, BTX procedures could be anticipated as an outpatient treatment option in Female Urology.

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