Presentation Authors: Laura Giusto*, Patricia Zahner, Samir Derisavifard, Jessica Rueb, Michele Fascelli, Courtenay Moore, Raymond Rackley, Sandip Vasavada, Howard Goldman, Cleveland, OH
Introduction: According to the safety insert for usage of intradetrusor onabotulinumtoxinA (BTX-A) injection, a patient must not have a urinary tract infection (UTI) at the time of the procedure. In practice, many patients are tested with a point of care urine dipstick (UD) in the office before the procedure. Some surgeons may choose to inject in the setting of a positive UD if the patient is asymptomatic. We aim to evaluate differences in adverse events (AE) in asymptomatic patients with and without a positive UD at time of BTX-A injection.
Methods: Intradetrusor BTX-A injections were retrospectively reviewed between 2016-2018. Exclusion criteria included: indwelling catheter, recent urine culture, recent antibiotic course, or no UD on the day of injection. Patient demographic data and adverse events (AE) were extracted. Positive UD was defined as any combination of positive blood, leukocyte esterase (LE), or nitrite. Negative UD was defined as complete absence of any blood, LE, or nitrite. Appropriate statistical tests were performed.
Results: 335 patients who underwent BTX-A injections over a two-year period met inclusion criteria. The majority received 100 units (56.7%) for a non-neurogenic diagnosis (73.4%). No clinically significant demographic differences were noted between groups. The overall rate of AEs, UTI, and urinary retention was 16%, 9%, and 3%, respectively. Compared to patients with negative UD, those with a positive UD had higher AE rates (18.3% vs 12.7%, p = 0.18) but this difference was not significant (Table 1). In both groups, the most common AE was uncomplicated UTI followed by urinary retention. There was no difference in the rates of unplanned phone calls, office visits, emergency department encounters, or hospital readmissions between those with positive vs negative UD. There were no major Clavien-Dindo-defined complications, and all AE were managed as an outpatient.
Conclusions: BTX-A injection with a positive UD defined as presence of LE, nitrite, or blood portends no statistically significant risk of adverse events compared to negative UD. Given these findings, surgeons may consider proceeding with BTX-A injection in a patient with a positive UD as long as they do not have symptoms of UTI.