Effectiveness of Vaginal Wall Slings in Treating Overweight Patients with Stress Urinary Incontinence after One Year Follow Up: Poster #NM46

Introduction: Injection of intravesical botulinum toxin (Botox) and urethral bulking agents (UBA) are contraindicated in the setting of a urinary tract infection (UTI). However, the diagnosis of a UTI is not standardized. Patients benefiting from these treatments have high rates of asymptomatic bacteriuria. We believe proceeding with treatment in asymptomatic patients despite a positive urinalysis (UA) results in few symptomatic UTIs, if a preoperative antibiotic and a “self-treatment” antibiotic for later use are given. We present our findings on UTIs in our female Botox and UBA patients. Methods: We reviewed medical records of female Botox and UBApatients between 8/2013-2/2016. There were 139 Botox procedures in 64 patients and 35 UBA procedures in 25 patients. Preoperative UA was obtained the day of procedure and considered positive if nitrites ormoderate leukocytes were present. Unless there were symptoms of a UTI, the treatment was given. A preoperative antibiotic was given. Catheterized urine cultures (UCx) were sent on positive UAs at time of procedure, after the preoperative antibiotic was administered. Results: Median age for the Botox and UBA groups was 63 years (range 18-92) and 62 years (range 25-92), respectively. In the Botox group, overall rate of positive preoperative UAs was 21%(28/135). Four of these had a positive UCx for an overall rate of 3% (4/135). These four patients remained asymptomatic and were treated postoperatively. By onemonth postoperatively, seven patients were seen in the office with a symptomatic culture-proven UTI for an overall rate of 5% (7/135). All seven patients were given antibiotics, none developed sepsis or were hospitalized. In the UBA group, overall rate of positive preoperative UAs was 34% (11/32). Five of these had a positive UCx for an overall rate of 16% (5/32). These five patients remained asymptomatic and were treated postoperatively. By one month postoperatively, two patients were seen in the office with a symptomatic culture-proven UTI for an overall rate of 6% (2/32). Both patients were treated with antibiotics and neither developed sepsis or was hospitalized. Conclusion: Delivering Botox and UBA with asymptomatic bacteriuria are safe as we demonstrate a low incidence of postoperative symptomatic UTIs. Strictly following the Botox and UBA delivery guidelines would result in unnecessary cancellation of many of our Botox and UBA patients with asymptomatic bacteriuria.