Overactive Bladder is common in elderly population. Intra detrusor Botox injection is a useful treatment (Supported in all standard guidelines) for this condition if medical management fails or unable to tolerate. However,  clinicians are much cautious to offer Botox injection in this age group due the fear of complications and risk of retention. The majority of data in existing literatures are from younger population and may not quiet represent  the  outcomes in elderly age group. Due to  lack of enough data regarding safety and outcome of this treatment in elderly population, this study was done.

A prospective study involving overactive bladder patients(Both idiopathic and neurogenic) over 75 years of age. Procedures were performed with Flexible cystoscopy under Local Anaesthetic (L/A) in outpatient clinic. Complications and outcomes were checked and recorded at follow ups. Symptoms and responses to treatments were assessed with ICIQ OAB and ICIQ UI questionnaire before treatment and at follow up in 6 weeks. Data was analysed using MS Excel software and Paired ‘t’ test was done to check statistical significance.

Among total 27 patients, 59%(16) were female, 41%(11) were male. Average age was 81.8±4.58(Range 75-89) years. Majority (81%) had Idiopathic Detrusor Overactivity(IDO), rest(19%) had Neurogenic Detrusor Overactivity(NDO). Average score for ICIQ OAB(Total score 16) before Botox was 10.32±2.69 and after 6.77±2.45(P<0.001). Average bother score(Total 40) before treatment was 32.27±2.45 and after 19.91±5.59(P<0.001), Average for ICIQ UI (Total 21) before treatment was 12.55±4.71 and after 8.55±3.98(P<0.001). 77.7%(21) were happy with symptomatic improvement and continued further Botox treatment. 10(37%) patients were doing Intermittent Self Catheterisation (ISC), although only 5(18.5%) patients commenced ISC after having Botox. 1(3.7%) patient had retention and another(3.7%) was readmitted with UTI.

In this audit majority patients were female as expected, average age was more than 80 years. There were statistically  significant improvements in symptomatic outcomes assessed by validated questionnaires. The overall success rates and symptomatic improvements corresponded with the standard literature and studies involving younger cohort.  In terms of complications, there was a bit higher incidence of doing ISC, which probably can be explained by some element of outflow obstructions  and detrusor weakness  are common in this age group. One patient(nearly 5%) had complete retention, which also needs to be carefully discussed at consultation.

Botox Treatment for overactive bladder is safe and effective in Elderly population, can be recommended  with careful discussion regarding need for ISC- the rate can be slightly higher than younger cohort .