Detail (Long)
Intradetrusor botulinum toxin (BTX) injection<br>
◦ 100U intradetrusor BTX injection improves OAB sx in male and female pts w/ inadequate response to, or who’ve experienced intolerable side effects from, antimuscarinics and/or β3 agonists.<br>
◦ Low side-effect profile<br>
◦ If pt doesn’t experience sx relief w/ β3 agonist, may bypass antimuscarinics and move directly to BTX.<br>
◦ May offer to pts who’ve declined oral pharmacotherapy<br>
◦ Offer w/ caution if primarily nocturnal sx. Significant ↓ in nocturia vs. placebo has marginal clinical significance.<br>
◦ Most-common adverse effects: UTI; incomplete bladder emptying requiring CIC; gross hematuria.<br>
◦ To r/o UTI, perform sx assessment and UA +/- cx before procedure; active UTI is a contraindication until treated.<br>
◦ Measure PVR before procedure. Perform BTX injection w/ caution if PVR ≥100-200 mL; account for voided volumes and voiding sx. [CP]<br>
◦ Long-term need for repeat injections (typically q3-12mo)<br>
◦ Pts w/ inadequate response to BTX 100U and minimal side effects may be offered BTX 200U, but monitor for adverse effects.<br>
◦ Techniques that either spare or include the trigone are effective.<br>
◦ Pts w/ adequate sx relief w/ no UTI or incomplete bladder emptying after BTX injection may opt for telemedicine in the f/u visit, although PVR and UA can’t be easily obtained.
◦ 100U intradetrusor BTX injection improves OAB sx in male and female pts w/ inadequate response to, or who’ve experienced intolerable side effects from, antimuscarinics and/or β3 agonists.<br>
◦ Low side-effect profile<br>
◦ If pt doesn’t experience sx relief w/ β3 agonist, may bypass antimuscarinics and move directly to BTX.<br>
◦ May offer to pts who’ve declined oral pharmacotherapy<br>
◦ Offer w/ caution if primarily nocturnal sx. Significant ↓ in nocturia vs. placebo has marginal clinical significance.<br>
◦ Most-common adverse effects: UTI; incomplete bladder emptying requiring CIC; gross hematuria.<br>
◦ To r/o UTI, perform sx assessment and UA +/- cx before procedure; active UTI is a contraindication until treated.<br>
◦ Measure PVR before procedure. Perform BTX injection w/ caution if PVR ≥100-200 mL; account for voided volumes and voiding sx. [CP]<br>
◦ Long-term need for repeat injections (typically q3-12mo)<br>
◦ Pts w/ inadequate response to BTX 100U and minimal side effects may be offered BTX 200U, but monitor for adverse effects.<br>
◦ Techniques that either spare or include the trigone are effective.<br>
◦ Pts w/ adequate sx relief w/ no UTI or incomplete bladder emptying after BTX injection may opt for telemedicine in the f/u visit, although PVR and UA can’t be easily obtained.