Overactive bladder (OAB) is considered a urinary emergency. Botulinum toxin A (BTX-A) is utilized for treating of refractory OAB, with various injection techniques tailored to the patient's preferences and co-morbidities. The aim of this study was to evaluate the effectiveness of intravesical botulinum toxin A injections, using both submucosal and intra-detrusor muscle methods in patients with overactive bladder.

The study was conducted, between 2023 and 2024, focusing on patients with urinary incontinence. Participants completed the Persian version of the ICIQ-LF questionnaire before receiving treatment. Fallowing this, 500 mg of BTX-A was injected into each group.Parients completed the ICIQ-LF questionnaire again one and three months after the injection.

The study found no significant differences in treatment outcomes between intra-detrusor and submucosal injection groups. This suggests that the two groups were comparable in terms of age, BMI, duration of symptoms, and other demographic and clinical characteristics. The ICIQ-LF scores decreased in both groups fallowing the injection, indicating an improvement in quality of life. However, there was no statistically significant difference in the effectiveness of the injection methods over time.

Our results show that both techniques effectively reduce the impact of urine incontinence on patients' quality of life, as evidenced by a significant decrease in ICIQ-LF ratings after the injection. However, there was no statistically significant difference between the two approaches over time. The improved results were maintained at the three-month follow-up, although there was a slight increase in scores compared to the one-month assessment. The lack of a notable difference in the P value (0.838) between the two groups indicates that both methods are similarly effective in alleviating the symptoms of overactive bladder (OAB).

Both submucosal and intra-detrusor injection methods significantly alleviate the impact of urinary incontinence on patients' quality of life, as demonostrated by the considerable decrease in ICIQ-LF scores after the injection. Nevertheless, no statistically significant difference was observed between the two techniques over time.

Chess-Williams R, Sellers DJ. Pathophysiological mechanisms involved in overactive Bladder/Detrusor overactivity. Current Bladder Dysfunction Reports. 2023;18(2):79-88
Ruffion A, Karam P, Forestier A, Denys P. Real-World Use of Intradetrusor Botulinum Toxin Injections: A Population-Based Study from France. Toxins. 2024;16(10):423.
Alshammari D, Yadav P, Ahmad I, Chancy M, Kim JK, Lorenzo A, et al. Intradetrusor Versus Suburothelial Onabotulinum Toxin A in Adults with Neurogenic and Non-neurogenic Overactive Bladder Syndrome: A Meta-Analysis. Archivos Espanoles de Urologia. 2024;77(4):368-77.