Botulinum toxin outcomes for idiopathic overactive bladder stratified by indication: lack of anticholinergic efficacy versus intolerability.

AIMS To determine if the outcomes of intradetrusor botulinum toxin A (BTX-A) injections for the management of refractory overactive bladder (OAB) symptoms are different if performed due to lack of anticholinergic efficacy versus medication intolerability. METHODS Retrospective chart review was performed on all patients undergoing intradetrusor BTX-A (BOTOX®, Allergan Inc., Irvine, CA) injections from 2004 to 2010 for the management of refractory idiopathic OAB with or without urge incontinence. All patients failed anticholinergic medications due to either lack of efficacy or intolerable side effects. Patient outcomes following BTX-A injections (150-200 units) were compared based on the primary reason for discontinuing anticholinergic medications (lack of efficacy vs. intolerability). Successful BTX-A injections were defined as those producing symptomatic OAB improvement warranting future repeat injections upon return of symptoms. RESULTS A total of 85 patients were included in the study. Overall, 58/85 (68%) reported symptomatic improvement following BTX-A injections. Successful outcomes were reported in 34/57 (60%) patients treated secondary to lack of anticholinergic efficacy versus 24/28 (86%) due to intolerable side effects (P = 0.02). CONCLUSIONS BTX-A injections are more successful in patients with anticholinergic intolerability as compared to patients with poor medication efficacy (86% vs. 60%, P = 0.02).