Objective: Little information exists about tolerability of intradetrusor injection of botulinum toxin type A (BoNTA) under local anesthesia. We sought to determine the degree of anxiety and discomfort anticipated by patients undergoing in-office BoNTA injection and compare it to the actual degree experienced.
Methods: Twenty-two patients with urgency, frequency, and/or urge incontinence were treated with intradetrusor injection of BoNTA. Patients were given a questionnaire before the procedure that included a visual analog scale (VAS) on which they reported anticipated pain as well as 2 questions regarding anxiety and expected pain. A total of 40 mL of 1% lidocaine was instilled and 10 mL of 2% viscous lidocaine was given intraurethrally. One hundred U or 200 U of BoNTA was injected using a rigid injection system. Patients were then given a second questionnaire that included the same VAS to record pain actually experienced, 2 questions comparing anticipated to experienced anxiety and pain, and one regarding willingness to undergo the procedure again.
Results: There was no difference between the mean anticipated and experienced VAS 3.60 (±3.09) versus 2.26 (±2.08), P = 0.0996. Fifty-nine percent reported the experience as much better or better than expected. Seventy-two percent reported that they would undergo the procedure again without reservation.
Conclusions: Intradetrusor injection of BoNTA in an office setting using local anesthesia is well tolerated by the majority of patients. The level of anxiety and discomfort experienced by most patients is not worse than anticipated. Most patients would be willing to undergo a repeat procedure using the same protocol.