Safety of intradetrusor onabotulinumtoxinA (BTX-A) injection in the asymptomatic patient with a positive urine dip

Samir Derisavifard, Laura Giusto, Patricia Zahner, Jessica Rueb, Howard B Goldman
Urology 2019 October 7

OBJECTIVES: To evaluate differences in adverse events (AE) in asymptomatic patients with a positive urine dip (UD) at time of intradetrusor onabotulinumtoxinA (BTX-A) injection versus those with a defined negative UD.

MATERIALS & METHODS: All intradetrusor BTX-A injections were retrospectively reviewed at a single institution between 2016 and 2018. Exclusion criteria included an indwelling catheter, recent positive urine culture, recent antibiotic course, or absence of UD on the day of injection. A positive UD was defined using 7 different definitions with varying combinations of any level of positive blood, leukocyte esterase (LE), or nitrite. Negative UDs were defined those excluded from the positive UD group. We compared multiple positive UD-defined groups to their respective negative UD cohorts with regards to outcomes and demographics.

RESULTS: A total of 212 patients underwent 335 cycles of BTX-A injections over a two-year period. The average age was 65 years (range: 21-90). The majority received 100 units (73%) of BTX-A for a non-neurogenic diagnosis (73%). The overall rate of AEs, urinary tract infection (UTI), and urinary retention was 14.6%, 9%, and 3%, respectively. In all groups, the most common AE was UTI followed by urinary retention. There were no major Clavien-Dindo-defined complications. There was no statistically significant difference in the total or categorical adverse event rates between positive and negative UD groups using all seven definitions of a positive UD (p=0.05-1.0).

CONCLUSION: These data do not support the practice of obtaining a pre-procedure UD in asymptomatic patients undergoing intradetrusor BTX-A injection for any indication; test results are unable to predict outcomes or adverse events.

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