Neurourology and urodynamics · 2026
Predictors of 2-Week Post-Void Residual After Intradetrusor OnabotulinumtoxinA Injection for Overactive Bladder: A Sex- and Neurogenic Status-Stratified Analysis.
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Patel Saawan D, Rosario Evan, Smith Ariana L
Аннотация
OBJECTIVE: Urinary retention rates after intradetrusor onabotulinumtoxinA (BTX-A) peak at 2 weeks, yet risk stratification by sex and neurogenic status remains limited. We evaluated predictors of 2-week post-void residual (PVR) and differences by sex and neurogenic bladder status using the largest retrospective cohort to date.
METHODS: We reviewed all BTX-A procedures at a single academic institution from January 2020 to June 2025. Patients younger than 18 years, those with mean preprocedural PVR ≥ 150 mL, prior pelvic radiation, or preprocedural catheterization requirements were excluded. Two-week PVR was analyzed using multivariable regression of demographics and urodynamic parameters, adjusting for total injections per patient, with subgroup analyses by sex-assigned-at-birth and neurogenic status.
RESULTS: A total of 824 patients underwent 2282 BTX-A injections. The cohort was predominantly female (95.9%) and non-neurogenic (93.7%), with mean preprocedural PVR of 24 mL, mean BTX-A dose of 120.8 units, and mean 2-week PVR of 66.7 mL. Higher preprocedural PVR was associated with higher 2-week PVR among female patients (β = 0.593 mL, 95% CI [0.303, 0.883]) and non-neurogenic patients (β = 0.555, 95% CI [0.284, 0.825]), but not among male or neurogenic patients. Higher BTX-A dose was similarly associated with higher 2-week PVR among female patients (β = 25.7 mL per 100 U, 95% CI [6.16, 45.2]) and non-neurogenic patients (β = 28.1 mL per 100U, 95% CI [10.5, 45.6]). Lower maximum flow rate (Qmax) was associated with higher 2-week PVR among female patients (β = -1.25 mL per mL/sec, 95% CI [-1.94, -0.56]), neurogenic patients (β = -17.4, 95% CI [-31.5, -3.26]), and non-neurogenic patients (β = -1.08, 95% CI [-1.74, -0.418]). Higher detrusor pressure at maximum flow (pDet@Qmax) was associated with higher 2-week PVR among female (β = 0.557 mL/cmH2O, 95% CI 0.136, 0.979]) and neurogenic patients (β = 2.68 mL/cmH2O, 95% CI 0.126, 5.23]), whereas lower pDet@Qmax was associated with higher PVR among male patients (β = -8.34 mL/cmH2O, 95% CI -12.9, -3.76]).
CONCLUSIONS: Pre-procedural PVR and BTX-A dose were consistent predictors of elevated 2-week PVR in females and non-neurogenic patients. These findings support sex- and neurogenic-specific risk stratification and dose considerations prior to BTX-A injection.
METHODS: We reviewed all BTX-A procedures at a single academic institution from January 2020 to June 2025. Patients younger than 18 years, those with mean preprocedural PVR ≥ 150 mL, prior pelvic radiation, or preprocedural catheterization requirements were excluded. Two-week PVR was analyzed using multivariable regression of demographics and urodynamic parameters, adjusting for total injections per patient, with subgroup analyses by sex-assigned-at-birth and neurogenic status.
RESULTS: A total of 824 patients underwent 2282 BTX-A injections. The cohort was predominantly female (95.9%) and non-neurogenic (93.7%), with mean preprocedural PVR of 24 mL, mean BTX-A dose of 120.8 units, and mean 2-week PVR of 66.7 mL. Higher preprocedural PVR was associated with higher 2-week PVR among female patients (β = 0.593 mL, 95% CI [0.303, 0.883]) and non-neurogenic patients (β = 0.555, 95% CI [0.284, 0.825]), but not among male or neurogenic patients. Higher BTX-A dose was similarly associated with higher 2-week PVR among female patients (β = 25.7 mL per 100 U, 95% CI [6.16, 45.2]) and non-neurogenic patients (β = 28.1 mL per 100U, 95% CI [10.5, 45.6]). Lower maximum flow rate (Qmax) was associated with higher 2-week PVR among female patients (β = -1.25 mL per mL/sec, 95% CI [-1.94, -0.56]), neurogenic patients (β = -17.4, 95% CI [-31.5, -3.26]), and non-neurogenic patients (β = -1.08, 95% CI [-1.74, -0.418]). Higher detrusor pressure at maximum flow (pDet@Qmax) was associated with higher 2-week PVR among female (β = 0.557 mL/cmH2O, 95% CI 0.136, 0.979]) and neurogenic patients (β = 2.68 mL/cmH2O, 95% CI 0.126, 5.23]), whereas lower pDet@Qmax was associated with higher PVR among male patients (β = -8.34 mL/cmH2O, 95% CI -12.9, -3.76]).
CONCLUSIONS: Pre-procedural PVR and BTX-A dose were consistent predictors of elevated 2-week PVR in females and non-neurogenic patients. These findings support sex- and neurogenic-specific risk stratification and dose considerations prior to BTX-A injection.