Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Obst
onabotulinum toxin A, Botulinum Toxins, Type A, Urinary Bladder, Overactive, Administration, Intravesical, Anesthesiology, Anesthesia
PURPOSE: To evaluate if the number of intravescial Botox injections decreases in patients who receive local anesthesia compared to systemic anesthesia.
BACKGROUND: Overactive bladder (OAB) is a common problem that affects up to 15% of women. An effective treatment option for refractory OAB is intravesical onabotulinum A toxin injection, brand name Botox, in which 100 units is administered through 20 injections per manufacturer guidelines into the bladder using a cystoscope. At a single site teaching institution with two practicing urogynecologists, there was a recent transition from performing this procedure under IV sedation or sometimes, general anesthesia, to local only anesthesia using intravesical lidocaine. The purpose of this study was to evaluate whether this transition reduced the number of injections that a patient receives. The clinical significance of a decrease in number of Botox injections will need to be further studied to see if the difference alters the durability of the procedure, as there is a current lack of evidence to support the minimum number of injections to achieve therapeutic effect.
METHODS: This was a retrospective study of patients at a single site teaching institution who received intravesical Botox procedures for idiopathic overactive bladder during January 2016 and March 2019. 52 patients met inclusion criteria, and 20 of these patients had multiple procedures during this defined time interval. The primary outcome was the number of Botox injections a patient received in a given procedure. RESULTS: 40.4% patients had the procedure under local only anesthesia, while 59.6% patients had systemic anesthesia. The median number [range] of Botox injections a patient received under local anesthesia was 10 [5-40], compared to 20 [10-40] under systemic anesthesia (P <0.001). The median dose of Botox in units for all procedures was 100, with range of 75-200. The median time interval [range] between the 1st and 2nd procedure within the defined time interval for patients receiving local only anesthesia was 32 [30-52] weeks, while the median interval for those who underwent systemic anesthesia was 38 [16-73] weeks (P = 0.61).
CONCLUSION: The number of intravesical Botox injections decreased if local anesthesia was used, compared to systemic anesthesia. This may have been due to provider desire to maintain patient comfort. It is possible that there is need for improvement in preoperative patient counseling or in the protocol for local anesthesia itself. There was a longer time interval between procedures performed under IV sedation, but this difference was not significant. This suggests possible increased durability with increased number of injections. However, it is possible a delay between procedures was encouraged due to increased cost and risk associated with systemic anesthesia. Further studies will be necessary to determine whether the decreased number of injections is associated with a change in efficacy of the procedure.
Brooker, Catherine; Brandes, Mary; Foust-Wright, Caroline; and Craig, Wendy, "Comparison of the Number of Intravesical OnabotulinumtoxinA Injections to Treat Overactive Bladder Using Local versus Systemic Anesthesia" (2020). Costas T. Lambrew Research Retreat 2020. 61.