Intermittent catheterisation after botulinum toxin injections: the time to reassess our practice

Introduction
Botulinum toxin has become a widely adopted treatment for patients with recalcitrant overactive bladder (OAB) symptoms. Some recommend the institution of clean intermittent self- catheterisation (CISC) if a post void residual exceeds 200 mls post treatment but there is no evidence for this recommendation. The aim of this study was to identify whether abstinence from CISC as a routine strategy for patients with a post void residual (PVR), post intra-detrusor botulinum toxin injections, is associated with any measureable adversity.
Methods
This was a cohort observation study. Patients with lower urinary tract symptoms (LUTS) attending a medical urology centre were observed pre and post botulinum toxin treatment. Intra-detrusal botulinum toxin injections were administered in the day treatment centre at a medical urology centre in London, United Kingdom. Patients were reviewed at follow up consultations to measure PVR.
Results
240 patients were studied; there were 215 women and 25 males. 196 patients (82%) received botulinum toxin injections and were not managed with CISC. 18% were using CISC prior to injections and continued. None of the 196 developed acute retention or significant voiding symptoms.
Conclusions
Our study indicates that routine administration of CISC based on an arbitrary PVR volume is unlikely to confer benefit. In order to avoid patients being deterred from botulinum treatment we recommend that CISC be reserved for those who have troublesome voiding symptoms as well as a raised PVR. It is unlikely that CISC, initiated on the basis of an arbitrary PVR volume would benefit the patient.

Published online: 23 January 2017