After informed consent is obtained, urinalysis will be collected. Post-void residual will also be assessed by bladder scan if not already documented in the electronic medical record in the prior three months.~Patients with positive urinalysis and symptomatic for UTI will be excluded from the study.~Patients will be randomized in a 1:1 ratio to one of two groups.~Group 1 will receive one dose of antibiotic prior to bladder onabotulinumtoxinA injection.~Group 2 will receive one dose of antibiotic prior to bladder onabotulinumtoxinA injection.~The same antibiotic will be continued for 3 days of total antibiotic administration with additional doses prescribed to the patient's pharmacy.~Bladder onabotulinumtoxinA injection and dosing will be completed based on the surgeon's standard technique and template.~Bladder onabotulinumtoxinA injection will be completed by staff or fellows in the Female Pelvic Medicine and Reconstructive Surgery division of the Genitourinary and Kidney Institute.~Patients will be followed for 4 weeks after the procedure.~At 4 weeks study investigators will contact the patient by phone to evaluate for any UTIs or adverse events not previously reported by the patient during the study period.~Chart review will occur at 4 weeks to assess for any unreported events.~Other than this additional phone call, post-operative patient management will not deviate from the standard of care.~Patients will be instructed to report symptomatic UTIs, urinary retention, or any other adverse events related to onabotulinumtoxinA or antibiotic to investigators.~Patients that report symptoms suggestive of a UTI will result in obtaining a urine culture.~Symptomatic, culture proven UTIs will be treated with appropriate antibiotics per the current AUA guidelines.~Symptoms suggestive of urinary retention, such as increased urinary frequency, voiding small amounts of urine, or feelings of incomplete bladder emptying, will result in obtaining a post void residual (PVR) and urinalysis.~Patients will undergo teaching to perform self, clean intermittent catheterization of the bladder per the discretion of the operating surgeon.~Any adverse reactions to the prescribed antibiotic will result in discontinuation of the antibiotic and managed according to the severity of the reaction.~Antibiotic regimens:~Allergy, prior urine culture resistance or another contraindication to first line antibiotic will result in the patient being prescribed second line antibiotic and so forth.~First line:~Group 1: trimethoprim / sulfamethoxazole 800/160 mg once pre-procedure Group 2: trimethoprim / sulfamethoxazole 800/160 mg once pre-procedure plus 800/160 mg every twelve hours for 6 total doses~Second line:~Group 1: cefalexin 500 mg once pre-procedure Group 2: cefalexin 500 mg once pre-procedure plus 500 mg every twelve hours for 6 total doses~Third line:~Group 1: nitrofurantoin 100 mg once pre-procedure Group 2: nitrofurantoin 100 mg once pre-procedure plus 100 mg every twelve hours for 6 total doses~Fourth line:~Group 1: ciprofloxacin 500 mg once pre-procedure Group 2: ciprofloxacin 500 mg once pre-procedure plus 500 mg every twelve hours for 6 total doses
The goal of this clinical trial is to evaluate the outcomes of differing durations of antibiotic prophylaxis with bladder onabotulinumtoxinA injection in patients with refractory overactive bladder.~The main question it aims to answer are:~• Is the incidence of post-procedure UTI similar between single-dose and multi-day durations of peri-procedural antibiotics?~Participants will be randomized to single-dose versus multi-day dose of antibiotic prophylaxis with bladder onabotulinumtoxinA injection.~Researchers will compare incidence of UTI in each group to see if there is a significant difference.