‏This study aimed to evaluate the efficacy of a modified intravesical botulinum toxin injection technique with fewer injection sites under local anesthesia compared to the conventional method in patients with idiopathic detrusor overactivity, focusing on urodynamic outcomes.

‏In this double-blinded randomized clinical trial, 78 adult female patients with idiopathic detrusor overactivity were divided into two groups. The conventional group received 20-site intradetrusor botulinum toxin injections under general or spinal anesthesia, while the modified group received five injections beyond the trigone under local anesthesia. The primary outcome was the comparison of urodynamic parameters between the groups, and the secondary outcomes included safety and tolerability assessments.

‏Baseline urodynamic parameters showed no significant differences between the groups. Post-intervention, both methods demonstrated significant improvements in bladder capacity, detrusor pressure, and overactivity episodes, with no statistically significant differences between the two groups. The modified technique was well tolerated without the need for conversion to general anesthesia. Adverse events were minimal and comparable between groups.

Our study demonstrated that reducing the number of botulinum toxin injection sites from 20 to 5, while using local anesthesia, results in similar improvements in urodynamic parameters compared to the conventional method. Significant increases in bladder capacity and reductions in detrusor pressure and overactivity episodes were observed in both groups, with no significant differences between them. Additionally, the modified technique was well tolerated by all patients without the need for conversion to general anesthesia, highlighting its feasibility for outpatient settings. This approach may provide a less invasive and more accessible alternative for treating idiopathic detrusor overactivity while maintaining efficacy and safety

‏Reducing the number of botulinum toxin injection sites while using local anesthesia is as effective as the conventional method for improving urodynamic outcomes in patients with idiopathic detrusor overactivity. This approach offers a well-tolerated, feasible alternative that may be performed in an outpatient setting, minimizing the need for general anesthesia.

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