title: Real-life clinical practice of onabotulinum toxin A intravesical injections for overactive bladder wet: an Italian consensus statement.
abstract: OBJECTIVE
  We developed a consensus on best practice in the real-life management of patients with overactive bladder (OAB) with onabotulinumtoxin A (Onabot/A).
  
  
  METHODS
  In March 2015, an interdisciplinary conference was convened. Eleven panelists were invited to review the literature, to present their personal experience and to respond to a number of questions from: "when do we propose Onabot/A treatment" to "when do you decide to re-inject a patient?" A summary of findings of the meeting was provided to all panelists for review and approval.
  
  
  RESULTS
  The following statements were agreed. Refractory OAB can be defined based on lack of adherence to first- and second-line treatments for OAB regardless of the underlying cause. Onabot/A treatment can be proposed to refractory OAB patients provided they are willing to perform intermittent catheterization if needed. Before treatment, uroflowmetry with post-void residual evaluation is needed to rule out voiding dysfunction, while urodynamics should be done in cases of complicated OAB wet. Urinary tract infection should be ruled out or treated before the injection. The injection can be performed in the endoscopy room, in an out-patient basis, with local anesthesia. Antibiotic prophylaxis should be initiated with oral drugs. A first follow-up visit should be planned 10-15 days after treatment and residual urine checked. Retreatment can be decided on patients' request, when symptoms worsen.
  
  
  CONCLUSIONS
  This consensus document provides a guide for the management of refractory OAB patients with Onabot/A in real life. A number of questions about the effectiveness of Onabot/A in real life remain open.
authors.affiliation: University of Perugia, Perugia, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Giannantoni
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Carbone
authors.affiliation: Azienda Ospedaliero-Universitaria Citta' della Salute e della Scienza, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Carone
authors.affiliation: Catholic University, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Cervigni
authors.affiliation: Careggi University Hospital, Florence, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Del Popolo
authors.affiliation: Tor Vergata University, Rome, Italy.
authors.forename: Enrico Finazzi
authors.initials: EF
authors.lastname: Agrò
authors.affiliation: University of Bari, Bari, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Giocoli Nacci
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palleschi
authors.affiliation: University Vita e Salute, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
authors.affiliation: Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Spinelli
authors.affiliation: Sapienza University, Rome, Italy. andrea.tubaro@mac.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000283:Administration, Intravesical; D000465:Algorithms; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin A; Onabotulinumtoxin A; Overactive bladder; Overactive bladder wet; Real-life practice; Urgency urinary incontinence