ArticleThe Canadian journal of urology2026
Clinical and urodynamic indicators of non-response to OnabotulinumtoxinA in idiopathic overactive bladder.
Article in The Canadian journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOnabotulinum toxin-A (BoNT/A) intradetrusor injection is an established, effective, and safe treatment for overactive bladder (OAB) refractory to anticholinergics. Although primary non-response to BoNT/A is infrequent, it remains clinically relevant. We investigated whether baseline clinical, demographic, or urodynamic characteristics could predict non-responders prior to treatment.
methodsA Retrospective analysis of 65 consecutive refractory idiopathic OAB (I-OAB) male and female patients treated with 100 U BoNT/A at Jewish General Hospital between 2005 and 2015 was conducted. Response defined as >30% increase in maximum cystometric bladder capacity (MCBC) at 12 weeks, confirmed clinically and through urodynamic studies (UDS). Non-response was verified by lack of improvement after the second intradetrusor injection.
resultsA total of 13 men and 52 women with a mean age of 70 years (range 21 to 94) were studied. At 12 weeks, 63% (41/65) of patients demonstrated a significant response in both symptoms and UDS (p < 0.05), while 37% (24/65) were non-responders. Non-responders exhibited significantly higher baseline first desire to void volume (FDV) and postvoid residual urine (PVR) (p < 0.05), with a trend toward greater bladder compliance (18.8 ± 15.1 vs. 13.3 ± 9.4 cmH2O, p = 0.09). Multivariate logistic regression identified no independent predictors of response.
conclusionsElevated baseline FDV and PVR are associated with poor response to 100 U BoNT/A in refractory I-OAB patients.
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