Introduction: Men with bladder outlet obstruction from benign prostatic hyperplasia (BPH) can present with symptoms of urge incontinence (UI) secondary to overactive bladder (OAB). Intradetrusor Botox injection is a well-established treatment for OAB, but its use at the time of holmium laser enucleation of the prostate (HoLEP) has not been previously reported. We investigated the safety and efficacy of concurrent intradetrusor Botox for OAB at the time of HoLEP. Methods: We prospectively identified men who had both BPH and UI secondary to OAB treated with concurrent injection of 200U intradetrusor Botox at the time of HoLEP. We propensity-scored matched to a cohort of HoLEP-only patients based on age, self-reported UI, pre-operative Michigan Incontinence Symptom Index (M-ISI) score, and prostate size. Complications and patient-reported outcomes were compared using Wilcoxon, paired T-, and Fisher’s exact tests as appropriate. Results: We identified 82 men with baseline UI – 41 treated with HoLEP + Botox (“Botox” group) and 41 with HoLEP only (“control” group). The groups were matched by age (mean 73.3 vs 72.2 years, P=0.7), prostate size (mean 106.7 vs 119.9g, P=0.2), and pre-op M-ISI score (mean 13.1 vs 11.0, P=0.4). Both groups had similar pre-procedure International Prostate Symptom Scores (IPSS) (mean 21.4 Botox vs 21.5, P=0.8). The control group had more men in retention at baseline (46% vs 10%, P<0.001). In the Botox group, there was a mean 6.2-point reduction in M-ISI (P <0.001) and 11.7-point reduction in IPSS (P <0.001) post-operatively. In the control group, there was mean 14.8-point reduction IPSS (P <0.001), but no significant change in M-ISI (P=0.2). In both cohorts, all men had a successful initial trial of void (P=1) and no men had post-operative urinary tract infection (P=1). Transient post-op retention was observed in 3 Botox patients (all managed with temporary catheter for 1-2 days) compared to 0 control patients, but this difference was not significant (P=0.2). Conclusions: Concurrent bladder Botox injection at the time of HoLEP is safe and associated with reduced patient-reported severity of urinary incontinence and improved IPSS. These findings support further investigation of simultaneous Botox injection and HoLEP in men with concomitant BPH and OAB. SOURCE OF Funding: None
