Intra-detrusor onabotulinumtoxin A (Botox®) injection is an efficacious treatment for overactive bladder (OAB). There is a lack of literature characterizing compliance with Botox therapy. We report the outcomes of Botox injection treatment at our institution and evaluate factors which correlate with continuation of maintenance injections.

A retrospective chart review was performed on all patients who received Botox injections from April 2013 to October 2017. Patients who received one injection of Botox were compared to those who received more than one. All data analysis was performed with SPSSv24.

We identified 175 patients who received at least one Botox injection. After the first injection, 86% (150/175) reported subjective symptom improvement. Of those who reported improvement, 54% (81/150) followed up for a second injection. Of those who reported no improvement 24% (6/25) also received a second injection. In total, 50% (87/175) returned for a second injection. Patients who received multiple injections were more likely to have perceived symptomatic improvement (p=0.034), and neurological disorders (p=0.011); those who received multiple injections were less likely to have side effects (p=0.027) (Figure 1). There was no significant difference in age, gender, BMI, or distance to clinic between these groups. Even among patients who reported improvement after Botox injection, compliance for subsequent injections was low (Figure 2).

Our data suggest that the presence of neurological disorders may influence the continuation of Botox therapy. Additionally, we found that despite reported symptomatic improvement, a significant proportion of patients did not follow up for repeat injection. This may be related to the presence of side effects which were less common in patients who chose to continue therapy.

There is a paucity of literature regarding the factors associated with maintenance of Botox injections to treat OAB. Our data shows that despite symptomatic improvement reported by 86% of patients in our study, there is a lack of continuation with onabotulinumtoxin injections. Further investigation is required to delineate the factors leading to discontinuation of Botox therapy for treatment of OAB.

Lindsey Cox and Anne P Cameron. OnabotulinumtoxinA for the treatment of overactive bladder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114914/