Real-Life Monitoring: Precise Onset of Action after BotulinumtoxinA Injection

Purpose: OnabotulinumtoxinA detrusor injection (Onabot-A DI) has been an established therapy for idiopathic overactive bladder and neurogenic lower urinary tract dysfunction for over a decade. However, the exact onset of its effect on symptoms, such as frequency, urgency, and urinary incontinence (UI), remains unclear. Materials and Methods: Female patients undergoing Onabot-A DI completed an automated bladder diary using an app-connected measuring cup (Diary Pod; Minze). The device automatically recorded voided volumes and micturition frequency, while urgency and UI episodes were manually registered in the accompanied app (Minze Flow). Data were collected 3 days preprocedure and up to 3 weeks postprocedure, securely stored, and analyzed through a cloud-based clinician portal. Results: Of the 62 patients, 27 (44%) had well-documented bladder diaries according to the protocol. The mean age of the patients was 63 years (range, 36-81 years). Despite the use of digital technology, the elderly patients also complied with the study protocol. The micturition frequency decreased significantly after 7 days (−2.7; P < .05), and the voided volume increased by 19.3 mL after 5 days (P < .05). Urgency voids significantly decreased by 21% after 1 day (P < .01), whereas UI episodes showed the first significant reduction (−2.4; P < .001) after 2 days. Forty-two percent of participants were completely dry. Conclusions: Onabot-A DI begins to act within 1 week postinjection, with urgency and UI improving first, followed by reductions in micturition frequency and increased voided volume. These real-world findings offer valuable insights for clinicians and patients, helping set realistic expectations for therapy progression.