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

INTRODUCTION AND HYPOTHESIS Botulinum toxin has become a widely adopted treatment for patients with recalcitrant overactive bladder (OAB) symptoms. Some recommend clean intermittent self-catheterisation (CISC) if a postvoid residual (PVR) >200 ml posttreatment, 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 PVR following intradetrusor botulinum toxin injections is associated with any measurable adversity. METHODS This was a cohort observation study. Patients with lower urinary tract symptoms (LUTS) attending a medical urology centre were observed before and after botulinum toxin treatment. Intradetrusal botulinum toxin injections were administered in the day-treatment centre at a medical urology centre in London, UK. Patients were reviewed at follow-up consultations to measure PVR. RESULTS Of the 240 patients studied, 215 were women and 25 were men, of whom, 196 (82%) received botulinum toxin injections and were not managed with CISC; 18% were using CISC prior to injections and continued. None of the 196 patients 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.