Comment on “Age and Urinary Retention in Women After Botox Treatment for Overactive Bladder”

Urinary urgency, frequency, and/or nocturia with or without urgency urinary incontinence is known as overactive bladder syndrome (OAB), and it has a prevalence among women of ~10% to 15%. In women older than 75, the prevalence increases to ~27%. One treatment option that has been shown to be effective is intra-detrusor onabotulinumtoxinA (BTX), with previous studies showing rates of urinary retention between 0% and 43% after treatment. A notable risk factor for treatment is patient age at the time of BTX administration, with some studies showing that individuals who had a postvoid residual volume (PVR) of >200 mL or who required clean intermittent self-catheterization (CISC) tended to be older, and other studies showing that age is not associated with CISC after BTX treatment. This study was designed to assess the direct association between age at the time of BTX treatment and urinary retention.

This study was a retrospective cohort study, and the inclusion criteria were all women undergoing treatment for OAB with BTX between 2017 and 2022. Exclusion criteria were having previously received BTX treatment at another institution, and concomitant procedures of placement of a sacral neuromodulation device, midurethral sling, bulking agent, or suprapubic catheter, as well as individuals who underwent treatment with agents other than BTX. The primary outcomes for this study were the need for catheterization and elevated PVR. Age groups were defined as patients 70 years or younger and patients older than 70.

The final analysis included 347 patients, with a median age of 71. When divided into the stipulated age groups, there were 166 in the 70 or younger group and 181 in the older than 70 group. A total of 28 patients required CISC after BTX treatment, and there was no significant difference in the rate of CISC by age group. Older patients were more likely to have PVR measured after the first injection ( P = 0.03), and PVR was <200 mL in 206 patients, 200 to 299 mL for 37 patients, and 300 mL or above for 26 patients. PVR was not significantly different between the 2 age groups. The incidence of urinary tract infection was also similar between groups. In addition, the proportion of patients who received additional injections did not significantly differ by age group.

These results indicate that in this cohort, there was no association between age and urinary retention after BTX for either of the primary outcome measurements. Furthermore, this study did not detect an association of retention after BTX with PVR volume at baseline or need for posttreatment CISC. Future studies should also attempt to identify other factors associated with urinary retention following BTX, including frailty, OAB subtypes, and concurrent medication use.

(Summarized from Scioscia NF, Edge P, Tackett S, Bynoe K, Harrington BJ, Ha B, Blomquist JL, Handa VL. Age and urinary retention in women after Botox treatment for overactive bladder. Urogynecology May 2026;32(5):559-565. doi: 10.1097/SPV.0000000000001715).