Incidence of Urinary Retention Following OnabotulinumtoxinA: A Multi-Centre Audit Challenging the Necessity of Universal CISC Training.

Abstract

BACKGROUND: Clinical guidelines, such as NICE NG123, prior to OnabotulinumtoxinA (BoNT-A) injections for overactive bladder (OAB), patients are counselled regarding clean intermittent self-catheterisation (CISC) and are willing and able to perform catheterisation if required. Subsequently, universal pre-procedure education imposes a significant burden on nursing resources, increases wait times, and may exacerbate patient anxiety. AIMS: To assess the incidence of urinary retention following BoNT-A at Northern lincolnshire And Goole foundation Trust (NLAG) NHS and evaluate the necessity of the current universal CISC education pathway. METHODS: A 3-year retrospective audit was conducted on 250 procedures at three hospital sites in NLAG, NHS Data included patient demographics, OAB aetiology, dosage, and post-procedural complications. RESULTS: The cohort (n = 250) had a mean age of 57.8 years (F:M 5.6:1). The rate of urinary retention was 4.0% (10/250; 95% CI 2.2%-7.2%), notably lower than published clinical trial benchmarks (6.5%-40%). Urinary retention occurred more frequently following first-time than repeat injections (6.4% vs. 3.2%); however, this difference was not statistically significant (Fisher's exact test, p = 0.27). Retention occurred more frequently in patients aged > 50 years and in male patients; however, subgroup analyses were limited by the small number of retention events. CONCLUSION: The low retention rate (4%) indicates that the number needed to train(NNT) to benefit a single patient is disproportionately high (NNT = 25). These findings support a transition from the current pathway to a selective, risk-stratified approach. We propose a "just-in-time" model where physical CISC instruction is reserved for high-risk cohorts or provided reactively only to those who fail a post-procedure voiding trial. This approach has the potential to improve hospital resource utilisation while enhancing the patient experience.