Intradetrusor OnabotulinumtoxinA (BTN/A) is a commonly utilised tool for the management of idiopathic overactive bladder (iOAB) refractory to medical management.The negative impacts of iOAB on quality of life and costs to individuals and health budgets are well documented.

A survey methodology was utilised with an aim to capture a wide range of experiences in addition to maintaining the anonymity and confidentiality of the participating specialists. A mixed methods survey was utilised to collect information about why specialists choose one type of anaesthetic over another. The survey questions were designed by the primary investigator (EK) and supervising urologist (KM). Currently practising qualified urologists and gynaecologists in Australia or New Zealand were included.

52% of specialists used general anaesthetic 12% sedation and 36% local anaesthetic. The overwhelming response was that anaesthetic choice was based on patient factors and preference, but the following themes also came to light. “Needed to overcome barriers to do outside of theatre setting” “Difficult access to outpatient cystoscopy” “I do Botox under local in the public partly due to theatre access. I do Botox under sedation in the private” “Many more patients are now routine done under local anaesthetic. However this is patient specific and the Change relates to maturation of my practice, more patients now have subsequent doses and now requesting to avoid GA and gradual development of better facilities with my own urodynamic set up to allow LA Botox. “ Multiple specialists changed from general to local anaesthetic based on their global experiences of the procedure in the USA or the UK.

By necessity BTN/A injections must be repeated every six to nine months, given this, the mode of anaesthetic delivery is an important consideration. In the public space, where long waiting times for elective procedures are commonplace, performing the procedure under local anaesthetic (LA) may increase the accessibility of the procedure. For aging populations, the deleterious effects of repeated GA’s, including cognitive, cardiac and pulmonary dysfunction should be considered. A third of surgeons in this survey perform BTN/A injections with LA only, which may negate concerns regarding risks of sedation or GA, as well as reduce costs and improve accessibility. However, if the procedure is to be performed with LA, the efficacy and tolerability of reduced number of injection sites should be a shared surgeon and patient consideration.