Intravesical botulinum toxin: Practice patterns from a survey of Canadian urologists

Authors

  • James Ross 1. Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
  • Duane Hickling 1. Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
  • Conrad Maciejewski 1. Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
  • Rhea Coriaty 1. Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
  • Humberto Vigil

DOI:

https://doi.org/10.5489/cuaj.7886

Keywords:

Botulinum Toxin, Overactive Bladder, Neurogenic Bladder

Abstract

Introduction: The objectives of this study were to conduct a survey of intravesical botulinum toxin administration practices in Canada, to compare practices based on level of training, and to identify barriers to delivery.

Methods: A voluntary online survey was sent to all members of the Canadian Urological Association. Respondents who provide intravesical botulinum toxin were questioned on training, surgical volume, workup, technique, and followup practices. Those with formal training in functional urology were compared to those without. Barriers to treatment delivery were identified.

Results: The overall response rate was 26% (148/570). Most providers (59%) perform 1–10 treatments/month. Preoperatively, 51% perform cystoscopy and 43% perform urodynamics. A majority (66%) give routine antimicrobial prophylaxis; however, regimen and duration varied. Most (79%) perform some treatments under local anesthetic, and 66% instill lidocaine solution for analgesia. There was a wide variation in technique with regards to the number of injections administered (range <10 to >20), volume administered per injection (range 0.5–2 mL), location of injections (bladder body vs. trigone vs. both), and depth of injection. Postoperative followup ranged from three days to three months. Respondents with fellowship training in functional/reconstructive urology performed more treatments per month and administered fewer injections per treatment. Common barriers to delivery included lack of experience/ training among non-providers (45%), lack of resources (34%), and lack of medication funding (32%).

Conclusions: Despite intravesical botulinum toxin being a widely accepted treatment, significant variability in practices and several barriers to delivery exist in Canada. Further study is required to optimize treatment access and quality.

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Published

2022-08-30

How to Cite

Ross, J., Hickling, D., Maciejewski, C., Coriaty , R., & Vigil, H. (2022). Intravesical botulinum toxin: Practice patterns from a survey of Canadian urologists. Canadian Urological Association Journal, 17(1), E15–22. https://doi.org/10.5489/cuaj.7886

Issue

Section

Original Research