Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade after Approval: A Single-Blind Study to Evaluate the Reduction in Pain in OnabotulinumtoxinA Detrusor Injection Using Different Injection Needles

• Published in: Toxins Vol. 16; no. 9; p. 395
• Main Authors: Schulte-Baukloh, Heinrich, Weiss, Catarina, Schlomm, Thorsten, Weinberger, Sarah, Borgmann, Hendrik, Höppner, Dirk, Haberecht, Kathrin, Neymeyer, Jörg
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.09.2024; MDPI
• Subjects: Adult; Aged; Anesthesia; Anticholinergics; Bladder; Botulinum toxin; Botulinum toxin type A; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - therapeutic use; botulinumtoxinA detrusor injection; Care and treatment; Darifenacin; Dermatology; Female; Gauges; Humans; Injection; Injections; Local anesthesia; Medical research; Medicine, Experimental; Middle Aged; Mirabegron; needle thickness; Needles; overactive bladder; Pain; Pain - drug therapy; Pain Measurement; Pain perception; Patients; Pelvis; Phenazopyridine; Quality of life; Sensation; Side effects; Single-Blind Method; Statistical analysis; Thickness; Trospium; Urinary Bladder - drug effects; Urinary Bladder, Overactive - drug therapy; Urinary incontinence; Urinary tract; Urogenital system; Urology; Germany; botulinumtoxinA detrusor injection; pain; needle thickness; local anesthesia; overactive bladder
• ISSN: 2072-6651; 2072-6651
• DOI: 10.3390/toxins16090395

Overactive bladder (OAB) has a significant impact on the quality of life; thus, it requires treatment that can be adhered to over a long period without undue side effects. The current treatment which uses an anticholinergic or β-3 agonist may fail to improve symptoms and has side effects, leading to high discontinuation rates. OnabotulinumtoxinA (OnabotA) detrusor injection has been approved for idiopathic OAB as a second-line treatment with good effectiveness and tolerability. This study used a visual analog scale (VAS) to assess the impact of the type of needle used for OnabotA detrusor injections under local anesthesia on the pain levels after each injection. This study included 68 female patients. We used three different needles with thicknesses ranging from 22 to 27 gauge, lengths between 4 and 5 mm, and different cuts. The sensation of pain was rated at each standardized injection location. Regardless of the needle used, the patients' perceptions of pain at the beginning of the procedure were rated as being less than the subsequent injections. Most pain sensations were rated as low to moderate. The mean pain sensation on the VAS was 2.5 ± 0.3 overall, i.e., for all patients and needles used. Statistically significant differences in pain sensation were rated only at some locations of the bladder (on the back wall and the right side of the bladder). The single needles averaged the following pain scores: 2.8 ± 0.3 for needle A (20 G, 4 mm), 2.1 ± 0.3 for needle B (27 G, 5 mm), and 2.6 ± 0.4 for needle C (20 G, 4 mm, sharp cut 15°). The 27-gauge needle caused significantly less pain, and it had no negative impact due to its length, which was 1 mm longer than the other needles. Thus, the needle thickness was a decisive factor in the patients' perceptions of pain.