Abstract
Abstract Background Patients with long-term indwelling catheters often experience refractory bladder pain and leakage due to detrusor overactivity. While intradetrusor Botulinum Toxin Type A (BoNT-A) injection is effective, the standard cystoscopic approach is invasive and carries risks such as urinary tract infection. Ultrasound-guided transabdominal injection may offer a less invasive alternative. This study compared the efficacy and safety of these two approaches. Methods This retrospective cohort study enrolled patients with long-term indwelling catheterization (≥ 6 months) who suffered from refractory bladder pain and/or catheter bypass leakage and received intradetrusor BoNT-A injection therapy between September 2022 and January 2025. Patients were divided into an intervention group (ultrasound-guided transabdominal injection) and a control group (cystoscopy-assisted transurethral injection) based on the injection technique. Primary outcomes included symptom control rate, modified Patient Global Impression of Improvement (PGI-I) score (0–10), and change in daily incontinence pad usage. Secondary outcomes included treatment-related complications (e.g., urinary tract infection, hematuria, urinary retention), treatment interval, patient tolerance, and positional requirements. Results A total of 98 patients were enrolled: 50 in the intervention group and 48 in the control group. Baseline characteristics were comparable. After treatment, no significant differences were observed between the groups in symptom control rate (92.0% vs. 93.8%, P = 0.724), PGI-I score (7.5 ± 1.8 vs. 7.8 ± 1.6, P = 0.365), or reduction in daily pad usage (3.2 ± 1.5 vs. 3.0 ± 1.7, P = 0.421), indicating comparable efficacy. The incidence of postoperative urinary tract infection was significantly lower in the intervention group (10.0% vs. 22.9%, P = 0.030). All patients in the intervention group completed treatment in the supine position, avoiding the lithotomy position required for cystoscopy, which improved convenience and comfort for patients with mobility limitations. Conclusion For patients with long-term indwelling catheters suffering from refractory bladder pain and leakage, ultrasound-guided transabdominal intradetrusor BoNT-A injection is a safe and effective treatment. Its efficacy is comparable to the cystoscopic method, and it offers procedural advantages including a potentially lower risk of urinary tract infection and a simpler operating position. This approach is particularly suitable for patients with limited mobility and shows promising clinical application.