Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naive Patients and Patients After Prostate Surgery

Background: Evidence regarding long-term results in male idiopathic overactive bladder (iOAB) patients is limited and rarely focuses on the effects of prior prostatic surgery. Objective: This study aims to identify the long-term treatment persistency and occurrence of adverse events of intravesical onabotulinum toxin-A (BoNT-A) injections in male iOAB patients after prostatic surgery (ie, transurethral resection of the prostate [TURP] or radical prostatectomy [RP]) compared with surgery-naive patients. Design, setting, and participants: In this retrospective, single-centre study, data from 477?patients treated with intravesical BoNT-A injections were collected. Outcome measurements and statistical analysis: Outcome data of 120?male patients with iOAB, with collectively 207?BoNT-A injections, were analysed and presented in this study. Results and limitations: At the last point of follow-up, 35?patients (29.2%) were still on active treatment. Twenty patients (16.7%) required de novo clean intermittent self catheterisation (CISC). Three groups were identified: 56?patients without prostate surgery, 40?patients with TURP, and 24?patients with RP prior to treatment. Discontinuation rates and patient-reported outcomes of BoNT-A treatment (none, insufficient, or satisfactory) were similar, but a significant difference was seen in de novo CISC (p = 0.004): 28.6% in the group without prior surgery, 7.5% in the TURP subgroup, and 4.2% in the RP subgroup. Odds of de novo CISC was significantly higher for the group without prior surgery than for both the TURP subgroup (odds ratio [OR] 4.9; 95% confidence interval [CI]: 1.33-18.31; p = 0.017) and the RP subgroup (OR 9.2; 95% CI: 1.14-73.96; p = 0.037). Conclusions: The data of this retrospective, single-centre cohort suggest that BoNT-A treatment leads to lower CISC rates in male patients after prior desobstructive surgery than in surgery-naive patients. Patient summary: This study describes the results of onabotulinum toxin-A (BoNT-A) injections in the bladder of male patients with idiopathic overactive bladder after initial prostate surgery compared with surgery-naive patients. The results showed that BoNT-A treatment leads to lower catheterisation rates in patients after prior prostate surgery than in men without prior prostate surgery. (c) 2020 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).