Introduction Urinary incontinence significantly impacts the lives of older adults increasing their susceptibility to falls, social isolation and long term care Intravesical Botulinum Toxin A (Botox) offers a well-established treatment for overactive bladders in women. In select centres, it can be administered under local anaesthetic, allowing access for frailer patients at higher risk from general anaesthetic and in whom anti-muscarinic therapies are best avoided. This project performed an analysis of geriatric patients who underwent intravesical Botox under local anaesthetic in an outpatient setting and assessed the tolerability and feasibility. Method 50 women (mean age 66, range 34–88) with overactive bladders underwent Botox administration in 2023. The procedure utilised local anaesthesia (Instillagel) while patients held a supine position with abducted hips on an outpatient couch. A LiNA OperaScope and injeTAK® needle facilitated administration. A sub-analysis focused on patients aged 75+. Pain levels were compared to past cervical smear experiences for reference. Results All 50 patients successfully completed the procedure. 15 were aged 75+ (mean 80.8, range 76–88), with 8 classified as ‘frail’ based on the Prisma 7 score (mean 2.3, range 0–5). The geriatric cohort reported lower average pain levels (1.8/10, range 1–3) compared to the non-geriatric group (2.2/10, range 1–5). Both groups pain perception was also lower than for past smears (2.9/10, range 1–4 vs. 3.4/10, range 1–7). Total ‘operative’ time was <3 minutes for all patients. Two non-geriatric participants experienced post-procedure UTIs, successfully treated with oral antibiotics (Clavien-Dindo II). Conclusion Intravesical Botox under local anaesthesia demonstrated promise as a safe and well-tolerated treatment for geriatric patients with overactive bladder, where lower levels of pain were reported compared to their younger counterparts. Tolerability was also better than previous smear tests and notably offers a relatable and novel comparison point to facilitate clearer counselling for patients and their families regarding this procedure.

中文翻译：

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2216 老年膀胱过度活动症和肉毒杆菌毒素 a：局部麻醉下门诊的可行性和耐受性


简介 尿失禁对老年人的生活有重大影响，增加了他们对跌倒、社会孤立和长期护理的易感性膀胱内肉毒杆菌毒素 A （Botox） 为女性膀胱过度活动症提供了一种行之有效的治疗方法。在选定的中心，它可以在局部麻醉下给药，使全身麻醉风险较高且最好避免使用毒蕈碱治疗的虚弱患者能够进入。该项目对在门诊接受局部麻醉下膀胱内肉毒杆菌毒素的老年患者进行了分析，并评估了耐受性和可行性。方法 50 名膀胱过度活动症女性 （平均年龄 66 岁，范围 34-88） 于 2023 年接受了肉毒杆菌毒素给药。该程序利用局部麻醉 （Instillagel），同时患者在门诊沙发上保持仰卧位，臀部外展。LiNA OperaScope 和 injeTAK® 针头促进了给药。一项子分析侧重于 75+ 岁的患者。将疼痛程度与过去的宫颈涂片经验进行比较以供参考。结果 50 例患者均成功完成手术。15 名年龄在 75+ 岁（平均 80.8，范围 76-88），其中 8 名根据 Prisma 7 评分（平均 2.3，范围 0-5）被归类为“虚弱”。与非老年组 （2.2/10，范围 1-5） 相比，老年队列报告的平均疼痛水平 （1.8/10，范围 1-3） 较低。两组的疼痛感知也低于过去的涂片（2.9/10，范围 1-4 对比 3.4/10，范围 1-7）。所有患者的总“手术”时间为 <3 分钟。两名非老年受试者经历了术后 UTI，成功使用口服抗生素治疗 （Clavien-Dindo II）。 结论 局部麻醉下的膀胱内肉毒杆菌毒素有望成为膀胱过度活动症老年患者的一种安全且耐受性良好的治疗方法，与年轻患者相比，患者的疼痛程度较低。耐受性也优于以前的涂片测试，并且显着提供了一个相关且新颖的比较点，以促进患者及其家人就此程序进行更清晰的咨询。