Practice Patterns of Turkish Urologists Regarding Intravesical Botulinum Toxin-A Injections for Overactive Bladder and Neurogenic Lower Urinary Tract Dysfunction: A Survey Study

Abstract

ABSTRACT Objective: We aimed to understand the practices of Turkish urologists using intravesical onabotulinum toxin-A (BoNT-A) injections for refractory overactive bladder (OAB) and neurogenic lower urinary tract dys- function (NLUTD) treatment, focusing on pre, peri, and postoperative man- agement. We also explored the potential influence of functional urology workload on these practices. Material and Methods: A cross-sectional sur- vey was circulated via the Turkish Association of Urology's WhatsApp group, collecting data on practices and preferences related to BoNT-A treat- ment. Statistical analysis was performed for comparisons between categori- cal groups. Results: 65 urologists participated. Most targeted population was NLUTD patients (40%). Preoperatively, spinal or general anesthesia was the preferred method (55.4%). For perioperative prophylaxis, second-generation antibiotics were popular (43.1%). BoNT-A dosage typically was 100 units for first OAB application (92.3%), while 200 units for first NLUTD application (70.8%). The injection site was usually the detrusor (44.6%), with most re- fraining from trigone injections (63.1%). Respondents with the functional urology workload >25%, favored 300 units for the first NLUTD application (p=0.009), trigone injections (p<0.001), and a second application between 3-5 months (p=0.016). Conclusion: Significant variations have been identi- fied in the usage of BoNT-A for the treatment of OAB and NLUTD by Turk- ish urologists, largely influenced by the functional urology workload. Understanding these differences will help refine treatment strategies and highlight the need for more research and more specific guidelines.