Subjective Efficacy of Suburothelial Versus Intradetrusor Botulinum Toxin for Overactive Bladder: A Retrospective Cohort Study

Objective: The goal of this study was to compare patient-reported efficacy of suburothelial versus intradetrusor onabotulinumtoxin A (BTX-A) in patients with refractory overactive bladder (OAB). Materials and Methods: This single-center, retrospective cohort study was a retrospective chart review of patients who received BTX-A injections to address refractory idiopathic OAB. The study was performed from 2014 to 2019 for 2 providers. Provider 1 used a suburothelial technique, while Provider 2 used an intradetrusor technique. Patients were excluded for lack of follow-up, co-injection with a urethral-bulking agent, and/or a diagnosis of neurogenic bladder. Patients included were BTX-A-naive and all received a starting dose of 100 units. Results: After cases were excluded, 133 patient charts were analyzed (Provider 1, n = 83; Provider 2, n = 50). Provider 1 had 65% (n = 54) of patients report improvement, while Provider 2 had 82% (n = 41) of patients report improvement. This difference was statistically different (p = 0.036). There was no statistical difference between the 2 groups for postprocedure urinary retention (p = 0.749). The prevalence of urinary tract infections (UTIs) within 30 days following the procedure was not significantly different between the 2 providers' groups (p = 0.329). Conclusion: In this patient population, intradetrusor injection was more effective than suburothelial injection and there was no statistical difference in the secondary outcomes of urinary retention and UTIs.