Introduction: Patients with long-term indwelling catheters may suffer from bothersome urinary symptoms, including bladder spasms, urine leakage, and urinary tract infections (UTIs) leading to a reduced quality of life.^[1][2][3] The use of onabotulinumtoxinA (BotA) has been poorly studied as a treatment option for this patient population. This study aimed to assess the role of intravesical BotA injections on bothersome urinary symptoms in patients with indwelling catheters.

Methods: We performed a single-institution, retrospective chart review of patients who underwent intravesical BotA injections with indwelling catheters from January 2010 to May 2020. Patients with urethral or suprapubic catheters placed for 12 weeks or greater were included. Patient demographics, diagnosis, indications for indwelling catheter, method of catheterization, and control of urinary symptoms were recorded.

Results: A total of 29 catheterized patients were treated with intravesical BotA injections (Table 1); 28 had a diagnosis of neurogenic lower urinary tract dysfunction. Sixteen patients had suprapubic catheters, while 13 had urethral catheters. Approximately 50% and 25% of the patients were concurrently on an anticholinergic and a beta-3 agonist medication, respectively (Table 2). Twenty-seven patients reported significant bladder spasms and 24 reported concerns with urinary incontinence prior to undergoing BotA. Twenty-two (81%) patients reported a decrease in bladder spasms and 17 (71%) reported a decrease in the amount of leakage per urethra after BotA injections (Figure 1). The average number of BotA treatments was three per patient (range 1–8 treatments) (Table 3). All patients that reported benefit in urinary symptoms were treated with 200 units of BotA. 

Conclusions: Our results suggest that BotA may be beneficial for treating bothersome urinary symptoms, mainly incontinence and bladder spasms, in patients with indwelling catheters. BotA appears to be safe and well-tolerated in this patient population.