MP48-18 ATTRITION RATES AND PREDICTORS OF LONG-TERM (> 5 YEAR) CONTINUATION OF TREATMENT WITH ONABOTULINUMTOXINA INTRADETRUSOR INJECTIONS

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-18 ATTRITION RATES AND PREDICTORS OF LONG-TERM (> 5 YEAR) CONTINUATION OF TREATMENT WITH ONABOTULINUMTOXINA INTRADETRUSOR INJECTIONS Ramy Goueli*, Jonathan Hong, Dayron Rodriguez, and Gary Lemack Ramy Goueli*Ramy Goueli* More articles by this author , Jonathan HongJonathan Hong More articles by this author , Dayron RodriguezDayron Rodriguez More articles by this author , and Gary LemackGary Lemack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Predictors of long-term continuation of therapy with intradetrusor injections of onabotulinumtoxinA (BTX) for refractory overactive bladder (OAB) are not well defined. The objective of this study was to examine the attrition rates of BTX therapy and potential demographic and urodynamic factors predictive of long-term continuation of therapy in patients with at least 5 years of follow-up. METHODS: We conducted an IRB-approved retrospective review of patients who underwent at least one BTX injection between December 2007 to October 2019 and had at least 5 years of follow up. Patients were instructed to continue therapy only if they perceived significant benefit. We examined pre-injection demographic, co-morbidities, medications, ambulatory status, bladder management, and urodynamic parameters. Multivariate logistic regression was used to identify independent predictors of long-term continuation of BTX and a Kaplan Meier survival analysis was conducted to determine attrition rates. RESULTS: 178 patients met our criteria, with 72 (38.8%) continuing therapy for at least 5 years, receiving an average of 1.6±1.9 injections per year. The mean follow up was 6.6±1.9 years. The average age of our cohort was 54.7±17.1 years, with 133 (71%) being female. At the time of first injection, 73 (39%) were on an OAB medication. At baseline, 87 (46%) were voiding, with 85 (46%) requiring clean intermittent catheterization or 14 (8%) using an indwelling catheter. There were 51 patients (27%) with idiopathic overactivity (iOAB). Of the 135 with neurogenic overactivity (nOAB), 57 (42%) had a spinal cord injury and 48 (36%) had either multiple sclerosis or transverse myelitis. Average time between BTX request and injection was 38.1±28.2 days. On multivariate analysis, female gender (OR 3.321, 95% CI 1.179 to 9.352, p=0.02) and diagnosis of nOAB (OR4.934; 95%CI 1.324 to 18.382, p=0.02) were predictors of continuing BTX. There were no urodynamic or baseline questionnaire predictive of continuing therapy. A Kaplan Meier survival analysis is shown (Figure 1) noting significantly varying attrition rates between subgroups. CONCLUSIONS: Nearly 40% of patients continue BTX therapy beyond 5 years. Female gender and a diagnosis of nOAB are predictive of a patient preference for continued BTX treatment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e701-e702 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ramy Goueli* More articles by this author Jonathan Hong More articles by this author Dayron Rodriguez More articles by this author Gary Lemack More articles by this author Expand All Advertisement PDF downloadLoading ...