Persistence with Intradetrusor AbobotulinumtoxinA for Refractory Idiopathic Overactive Bladder and Outcomes in Patients Who Continued Treatment: A Retrospective Single-Center Cohort Study

Intradetrusor abobotulinumtoxinA (aboBoNT-A) is used off-label for refractory idiopathic overactive bladder (OAB), but real-world data on persistence are scarce. This study aimed to describe persistence and reasons for discontinuation in all treated patients and to report outcomes in those who continued treatment. We retrospectively reviewed all toxin-naïve patients who received a first injection of aboBoNT-A (500 Speywood units, 30 sites, trigone included) at a single center between 2013 and 2022; each injection was followed for at least 6 months. Of 232 patients, 97 (41.8%) received at least one repeat injection; the main reasons for stopping were loss to follow-up (17.7%), procedure cost (13.4%), adverse events (9.9%) and lack of efficacy (8.6%). Effectiveness and safety were assessed only in these 97 patients, at their last injection. The International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) score decreased from 16.7 ± 2.8 to 12.3 ± 2.6 at 2 weeks (p < 0.001). Mean post-void residual volume rose from 16 to 79 mL (p < 0.001); 30.9% had at least 100 mL, none exceeded 200 mL and none required catheterization. The interval to re-injection was under 6 months in 24.7%, 6–12 months in 37.1% and over 12 months in 38.1%. Limitations include the retrospective design, outcome data restricted to continuers and an early outcome assessment. AboBoNT-A appears effective in patients who continue treatment, but most patients discontinue, and cost is a modifiable barrier.