Intradetrusor injections of OnabotulinumtoxinA (Onabot/A) are an established treatment for overactive bladder (OAB), usually performed in inpatient setting. Aim of the study was to evaluate the feasibility, safety and patient’s reported satisfaction of intradetrusor Onabot/A injections performed in an outpatient clinic setting in patients with idiopathic (iOAB) and neurogenic (nOAB), with long-term follow-up.

From July 2019 to February 2026, patients with iOAB or nOAB underwent intradetrusor Onabot/A injections in an outpatient clinic (100 U for iOAB, 200 U for nOAB). Exclusion criteria were spinal cord injury at or above T6 and recurrent urinary tract infections (UTIs). Baseline and follow-up evaluation included a 3-day voiding diary, urinalyses and urine culture, uroflowmetry, and post-void residual volume (PVR). The procedure was performed under intravesical local anesthesia using 2% lidocaine diluted in 50 ml of saline, instilled for 20 min. Antibiotic prophylaxis was prescribed for 3 days, and patients were observed for 60 minutes post- procedure. Intra- and postoperative complications were recorded. Patient satisfaction (VAS#1), and procedural pain (VAS#2) were assessed using visual analogue scale. Follow-up visits were scheduled at 1 and 3 months, and every 6 months thereafter. Safety and feasibility were defined as the absence of major complications. High satisfaction was defined as VAS score >6 (0:worse; 10:best). Patients were also asked whether they would repeat the procedure using the same protocol.

142 patients were treated (91 females, 51 males), with a mean ± SD age was 45.8 ± 13.6 years; 93/142 (65.5%) had iOAB. Mean follow- up was 75.2 ± 5.3 months. All clinical parameters showed significant improvement at last follow-up (Table). Repeated Onabot/A treatments were performed in 86/142 patients (60.6%), with a mean of 4.9 ± 0.3 treatment cycles. Mean VAS#1 and VAS#2 scores at last follow- up were 7.7 ± 0.4 and 4.9 ± 1.2, respectively. Satisfaction was significantly higher in patients undergoing repeated injections (p< 0.001), with no differences between iOAB and nOAB. 29/142 (20.4%) previously treated in an inpatient setting reported higher satisfaction with the outpatient protocol (p< 0.001). No major complications occurred. All the patients declared willingness to repeat the procedure under local anesthesia.

Our findings confirm that intradetrusor Onabot/A injections can be safely delivered in an outpatient clinic setting, with excellent long-term outcomes. The low pain perception, high satisfaction rates, and absence of major complications support the feasibility of this protocol, even in patients requiring repeated treatments. Compared to inpatient administration, the outpatient approach appears to improve patient experience while maintaining efficacy and safety, potentially optimizing healthcare resource utilization.

Intradetrusor Onabot/A injections performed in an outpatient clinic setting are feasible, safe, and well tolerated in both idiopathic and neurogenic OAB. This protocol represents a reliable and patient-centered alternative to inpatient management, also in the long term.