Abstract: PD39-11
Sources of Funding: none

Introduction

Intradetrusor onabotulinumtoxinA (BTX?A) BTX?A injections are an established third?line therapy for the treatment of overactive bladder (OAB). Incomplete bladder emptying requiring clean intermittent catheterization (CIC) is a side effect that limits patient acceptability of BTX-A. There are studies that have evaluated risk factors that predispose to need for CIC, but few have looked at parameters that may confer protection against CIC. Herein we present an initial report of a cohort of men who have undergone prostatectomy and subsequent BTX?A for OAB. _x000D_ _x000D_ _x000D_

Methods

A retrospective chart review of patients receiving BTX?A for OAB refractory to antimuscarinics and/or beta 3agonists from 2010 to 2016 was performed. We sought to identify predictors of elevated post?void residual (PVR) leading to CIC in patients not expected to CIC post treatment. A subset of men who had undergone prostatectomy for benign or malignant disease (open or robotic radical prostatectomy (RP), or transurethral procedure (TUR) for BPH were identified. All men received 100 units of onabotulinumtoxinA under local anesthesia by flexible cystoscope. PVR was measured 2 weeks after the procedure. We generally recommend CIC for PVR 200 ? 349 ml with symptoms or greater than 350mL with or without symptoms. Clinical variables were correlated with PVR/CIC at their subsequent evaluations. Patients with neurogenic DO and those performing CIC prior to BTX-A injection were excluded._x000D_ _x000D_

Results

71 men were identified. Of these, 45 (63.4%) had surgical interventions on their prostate; 23 (32.4 %) had open or robotic RP and 22 (31 %) had a TUR for BPH. The overall rate of CIC was 12.7%. Three (13.6%) men in the TUR group required CIC vs. 6 (23%) who had an intact prostate No men in the RP group required CIC. The median post BTX-A PVR in the RP group was 44 ml when compared to 104 in the TUR group and 197ml in the group with intact prostates. (Table)_x000D_

Conclusions

The rate of CIC in men receiving BTX?A for OAB in our cohort was 12.7%, somewhat higher than is seen in women. Prior RP appears to have a protective effect against CIC (p=0.02) and elevation of PVR (p=0.001). No man required CIC after RP. Prior TUR does not confer protection against CIC (p=0.5) but may protect against elevation of PVR (p=.03). A proposed mechanism for better emptying after surgery may be the ability to Valsalva void._x000D_

Funding

none