Safety and Feasibility of Virtual Visits After Clinic Botox Injection

Objectives: To compare event rates for urinary tract infection (UTI) and intermittent catheterization (CIC) before and after implementation of a protocol for post-operative phone calls after in-clinic injection of onabotulinumtoxinA (Botox) injection, and to determine need for face-to-face follow-up after implementation of this new protocol.

Methods: This study took place at a safety-net hospital, where patients can experience significant barriers in presenting for face-to-face visits. In-clinic injection of Botox began in our clinic 12/14/21, and initially all patients were scheduled for a 2-week in-person visit for PVR and urine studies. Starting 1/17/23, to alleviate the burden of this in-person visit, patients were instead scheduled for a 2-week phone visit. At this phone visit, patients were screened using a standardized symptom questionnaire as well as validated questionnaires, and were asked to return for a face-to-face visit if they expressed worsening symptoms, dysuria, or symptoms of incomplete emptying. Patients in these two groups -- those who had face-to-face visit pre-implementation and those who underwent phone visit post-implementation –were eligible for inclusion in this study if they received no more than 100 units of Botox, completed scheduled follow-up, and answered all screening questionnaires. Demographic variables and rates of subjective improvement, post-procedure symptoms, need for face-to-face visit (if undergoing phone visit), PVR, and rates of culture-proven UTI and need for CIC were compared between groups. Continuous variables were analyzed via t-test and categorical variables with chi-squared tests.

Results: Thirty-five patients in the face-to-face visit group and 40 patients in the phone-visit group met eligibility criteria for the study. Demographic characteristics were similar between groups. There was no difference in subjective improvement or symptoms of dysuria or incomplete emptying between groups. There was also no difference in rate of culture-proven UTI (11.43% in-person vs 2.5% phone visit), PVR, or need for CIC (2.86% in-person vs 0.00% phone visit) between groups. For those who underwent a phone visit, though the average PGI-I score was 2.45, UDI-6 scores decreased significantly after treatment (pre 37.39, post 15.51, difference -21.89, p < 0.01). 27.50% of patients who had a phone visit were asked to return for a face-to-face visit based on responses to the screening questionnaire, but this did not correspond with a higher rate of complications among the phone-visit group.

Conclusions: Post-procedure phone visits are safe and feasible to perform after in-clinic Botox. The implementation of this new protocol has the potential to alleviate the burden of face-to-face visits on an under-resourced group of patients without placing them at increased risk of infection or urinary retention.