Glickman Urological & Kidney Institute Outcomes

The Glickman Urological Institute Center for Female Pelvic Medicine and Reconstructive Surgery sees many patients with both overactive bladder (OAB) and refractory OAB (when first-line behavioral and second-line medication approaches do not work or are not tolerated). Among the options for refractory OAB, the center commonly uses sacral neuromodulation and onabotulinum toxinA injections (BTX) (Botox®, Allergan). With the use of BTX, the rate of urinary tract infections post procedurally has been quoted in the literature to be between 5%-20%. To minimize this risk, one typically administers oral antibiotics around the time of the procedure; however, the FDA and drug package insert recommends 1-3 days of pre-treatment antibiotics with 1-3 days of post-treatment antibiotics. This differs from world-wide best practice statements. Using this discrepant periprocedural antibiotic regimen, clinicians at the center performed a retrospective cohort analysis of patients with both idiopathic and neurogenic detrusor overactivity who underwent BTX injections with different antibiotic routines. Those routines were: single dose vs no antibiotics, 3-7 days post procedure vs no antibiotics and 3-7 days vs single dose antibiotic.