Efficacy, Satisfaction, and Compliance: Insights from 15 Years of Botulinum Toxin Use for Female Urgency Urinary Incontinence

Why look at 15 years of botulinum toxin treatment for female urgency urinary incontinence (UUI)? Well, UUI can seriously disrupt a woman’s quality of life, especially when medical treatments don’t work. Our 15-year study aimed to understand how botulinum toxin has performed as a long-term solution for these patients in real-life conditions, and the results are encouraging. However, some factors do affect its success.

Among the 368 women who received bladder Botox injections, over 74% managed to completely stop using pads. That’s a huge improvement, as not needing pads anymore signals a much better control of incontinence. Nearly 60% of the women needed repeated injections, and younger patients and those who were satisfied with the results were the most likely to return for further treatments.

So, what affects the treatment’s success? We found two main factors: how many pads the patients used before treatment and whether they had undergone a sling procedure for previous stress urinary incontinence. Women who used fewer pads before the treatment were more likely to achieve a pad-free state afterward. On the other hand, women who had previously a sling surgery were less likely to get the same level of success.

Regarding the time between treatments, women in this study usually waited about 18 months before needing another injection. This is longer than the 6-month interval suggested in initial trials, but it makes sense when we consider the logistical challenges these women faced in our reality and personal preferences to delay the next treatment.

But why do some women choose not to continue treatment? Some are satisfied with the residual effects of the injection, and even though the full benefit may not last, they still feel good enough to postpone the next session. Others find the procedure too invasive, especially since in our department it’s typically done with sedation in a surgical setting. In other cases, UUI might have spontaneous improvements, which we know from the natural history of the overactive bladder syndrome.

The side effects were mild, with just 1% of patients needing a temporary catheter after the injection and around 8% experiencing urinary tract infections that were treated with antibiotics.

Over these 15 years, it is clear that botulinum toxin injections are an effective and safe option for many women with UUI. While certain factors, such as sling history and the number of pads used before treatment, can influence outcomes, this treatment remains a solid choice for improving the quality of life for these patients.

Written by: Margarida Manso, MD, Urology Department, Centro Hospitalar Universitário São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

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