The objective of this study was to determine if the method of rebooking intravesical Botulinum neurotoxin A injections for treatment of detrusor overactivity causes treatment delays. The records of patients diagnosed with urodynamically proven detrusor overactivity treated with Botox® between March 2005 and October 2018 were included in a retrospective multicentre case series. Rebooking method was categorised into: (i) patient-initiated rebooking methods, (ii) doctor-initiated rebooking methods and (iii) automatic rebooking. Primary outcome was the proportion of patients with delay in reinjection >1 month after cessation of effect. A total of 336 patients were included in this study and results showed that 180/336 underwent a second and 122/180 a third cycle of Botulinum neurotoxin A. Patient- reported efficacy ranged from 73–84%, urinary tract infection rate was 8–11% per cycle and de novo urinary retention rate was 8.2–16.1% per cycle. The method of rebooking was patient-initiated in 45% (n=68) of cases and doctor-initiated in 55% (n=83) for the second injection. The rate of delay to retreatment was not clinically significant between the two groups at 33% and 37%, respectively. For those who progressed to a third cycle, the method of rebooking was automated in 11% (n=12) of patients and doctor- or patient-initiated rebooking in 89% (n=97). Automatic rebooking method resulted in a significantly lower rate of delay to injection (8% vs 44%, p=0.026). Significant delays occur in the reinjection of intravesical Botulinum neurotoxin A for detrusor overactivity. These delays can be reduced by utilising an automatic rebooking method once dose and duration of effect are established.
The purpose of this review was to explore the current evidence for pelvic floor muscle training alone, or in combination with exercise, in the prevention of stress urinary incontinence during pregnancy. The aim of this review was to determine evidence-based recommendations for clinical practice. Electronic databases were searched in July 2021 for studies published from 2014 to 2021. Randomised controlled trials, cohort studies, reviews and systematic reviews were included if they assessed the effect of pelvic floor muscle training on preventing stress urinary incontinence or unspecified urinary incontinence in pregnant women. Thirteen papers – one meta-analysis, four systematic reviews, four reviews, and four randomised controlled trials – were included in this review. Despite results generally demonstrating a trend towards pelvic floor muscle training having a protective effect in this population, it remains unclear whether the effects are enough to be clinically meaningful. Greater effects were observed in studies where women were appropriately supervised and had sufficient training dosage to elicit pelvic floor muscle strength adaptations. Further research demonstrating consistency in dosage, how pelvic floor muscle strength is assessed and measured, and monitoring program adherence, is required.