Examining the need for clean intermittent self-catheterisation following intra-detrusor botulinum toxin injection: A retrospective analysis

Objective: Intra-detrusor botulinum toxin (IDBT) injection is a proven treatment for detrusor overactivity (DO) but carries a low risk of transient urinary retention. Despite this, hospitals invest in educating patients on clean intermittent self-catheterization (CISC). This study examines whether pre-IDBT CISC education is necessary. Methods: In this retrospective cohort study, 67 patients underwent IDBT over 9 months. All received CISC education from a Clinical Nurse Specialist (CNS) and a follow-up phone consultation 2 weeks later. The primary outcome was new or increased CISC needs post-IDBT, with secondary outcomes assessing the cost of CISC education, and factors associated with CISC requirement. Results: The study included 67 patients, 9 (13.4%) developed a new or increased need for CISC following IDBT. Subgroup analysis of five patients with sustained CISC needs showed males and those with idiopathic detrusor overactivity (IDO) were at significantly higher risk. In addition, CISC naivety and lower IDBT doses strongly correlated with urinary retention in this subgroup. Educating patients on CISC required €3240.82 and 52 hours of CNS time. Conclusion: Prioritising CISC education for these high-risk groups, particularly males with IDO, could effectively address up to 90% of patients developing sustained CISC needs, optimising resource allocation and reducing unnecessary costs. Levels of evidence: This study is comprised of Level 2b evidence as per the Oxford Centre for Evidence-based Medicine Levels of Evidence (March 2009).