In 3 randomized, controlled trials, the most common adverse event (AE) of intradetrusor injection of botulinum toxin A was increased postvoid residual, which may necessitate clean intermittent catheterization. Thus, patients should be counseled about the potential need for clean intermittent self-catheterization (CIC).
A placebo-controlled study reported that the overall incidence of least 1 AE in treated patients was not significantly different from that in the placebo group. [4] The more frequently reported AEs across the studies were urinary tract infection and mild hematuria.
A dose-ranging study including both neurogenic detrusor overactivity (NDO) and idiopathic detrusor overactivity (IDO) patients reported that patients who received 100 U of botulinum toxin A had a significantly smaller postvoid residual urine volume than patients who received 150 U or 100 U at 1 month. [2] One study reported a mild case of asthenia after injection of botulinum toxin A 300 U, which persisted for 10 days. [5]
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Injection sites using minimally invasive outpatient technique. Flexible cystoscope with superfine 27-gauge disposable needle is used to inject onabotulinumtoxinA (BOTOX; Allergan, Irvine, CA) into bladder while avoiding trigone. At equally spaced points, 30 distinct injections, each containing 1 mL, are introduced
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Gross anatomy of the bladder.
