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

Authors

Faysal Elzawy, Mark Roger, Shazad Laghari, Ali Alali, Mathew Thomas, Prateek Verma

Published in

Neurourology and urodynamics. Sep 07, 2026. Epub Sep 07, 2026.

Abstract

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.
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.
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.
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.
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.

PMID:
42704052
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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