(Poster 35) Development of UTI Following Intra-detrusor Onabotulinum Toxin A

Objectives: To determine risk factors for associated with developing a urinary tract infection (UTI) following intra-detrusor onabotulinum toxin A (Botox) injections for the treatment of overactive bladder.

Methods: This was a multi-institution retrospective cohort study that included female patients 18 years of age or older who underwent intra-detrusor Botox (CPT 52287) in the office or operating room between January 2013 and January 2024. Patient demographic information and comorbidities were collected. Urodynamic parameters and periprocedural data including pre-operative urinalysis or urine culture, Botox dose, pre- and post-procedure antibiotic use, and location of procedure (office or operating room) were recorded. The primary outcome was UTI within 1 month of the Botox injections, diagnosed by symptoms and a positive urine culture. Secondary outcomes included UTI within 3 months and urinary retention. Multivariable logistic regression was performed for the primary and secondary outcomes. A sub-analysis of patients with recurrent UTI (rUTI) diagnosis before the Botox procedure was also performed.

Results: There were 604 patients who met inclusion for the study. The average age was 64.8 years (SD 13.3), and average BMI was 33.4 kg/m2 (SD 8.4). A large proportion of the cohort was White (70.7%) and the most common indication for Botox was urge urinary incontinence (69.7%). There were 65 patients (10.8%) who received a UTI diagnosis within 1 month and 67 patients (11.1%) within 3 months. Within the entire cohort, 10.4% (N=63) had a diagnosis of rUTI prior to receiving Botox. Of the patients with a history of rUTI, 13 patients (20.6%) were diagnosed with acute UTI within 1 month and 18 patients (28.6%) diagnosed within 3 months. On multivariable logistic regression, prior rUTI diagnosis (OR 2.71, 95% CI 1.35-5.45), indication for Botox as OAB-dry (OR 1.04, 95% CI 1.02-1.06), and development of post-procedure urinary retention (OR 2.44, 95% CI 1.10-5.45) were associated with increased odds of developing UTI at 1 month. At 3 months, higher maximum flow rate on pre-procedure urodynamics was associated with decreased odds of UTI (OR 0.95 per mL/sec, 95% CI 0.92-0.99), while prior rUTI diagnosis was again associated with increased odds of UTI (OR 3.62, 95% CI 1.57-8.38).

Conclusions: Patients with a history of rUTI prior to receiving intra-detrusor Botox have a higher likelihood at both 1 and 3 months for developing UTI which may aid in their periprocedural counseling.

Table 1. Patient demographics, comorbidities and outcomes (N=604)
*UTI – Urinary Tract Infection
!PVR – post void residual

Table 2. Multivariable logistic regression for odds of developing UTI within 1 month and 3 months following Botox
*rUTI – recurrent urinary tract infection
!UDS – urodynamics