MP76-04 PREDICTING WHICH PATIENTS WILL ONLY UNDERGO A SINGLE ONABOTULINUMTOXINA INJECTION: RESULTS FROM A TERTIARY REFERRAL CENTER

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-neurogenic Voiding Dysfunction1 Apr 2014MP76-04 PREDICTING WHICH PATIENTS WILL ONLY UNDERGO A SINGLE ONABOTULINUMTOXINA INJECTION: RESULTS FROM A TERTIARY REFERRAL CENTER Rebecca Lavelle, Burhan Coskun, and Gary E. Lemack Rebecca LavelleRebecca Lavelle More articles by this author , Burhan CoskunBurhan Coskun More articles by this author , and Gary E. LemackGary E. Lemack More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2397AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES OnabotulinumtoxinA (BTX) detrusor injection is an effective treatment for patients with neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). Still, not all patients request repeat injections. We sought to identify patient characteristics associated with the decision to not request repeat BTX injections. METHODS We analyzed demographic (including questionnaire) and urodynamic (UDS) data from an IRB approved database of patients with neurogenic bladder conditions and OAB. Patients were excluded for: prior inclusion in a BTX trial (n=6), deceased from unrelated causes (n=2), initial injection within the last 9 months (n=27). RESULTS From January 2009 through August 2013, 109 unique patients underwent a total of 206 injections. All patients were invited to call for repeat injection any time three months after the original injection. Of the 74 patients (59 NDO, 15 OAB) who met inclusion criteria, 56 (76%) underwent or have scheduled repeat injections (RI), and 18 (24%) had a single injection only (SI). In the SI group, the indications for injection were OAB (44.4%) and NDO (55.6%), and the corresponding values in the RI group were OAB (12.5%) and NDO (87.5%), (p=0.0065). Of the SI patients with OAB, 4 of 8 patients had secondary diagnoses: 3 with prior prostate cancer therapy, 1 with Painful Bladder Syndrome (PBS). Of the RI patients with OAB, 3 of 7 had secondary diagnoses (prior urologic surgery or pelvic radiation). The most common reasons for a SI were insufficient response (66.7%) or dissatisfaction due to de novo clean intermittent catheterization (CIC) (16.7%). Of the 12 with insufficient response, 6 required other intervention (catheterization, augmentation, cystectomy). De novo CIC was required in 27.8% of those in the SI group and 3.6% in the RI group (p=0.0079). Baseline UDS and questionnaire data, shown in Table 1, did not differ between groups. CONCLUSIONS In our experience, patients with refractory complex forms of OAB were more likely to have a SI only. Insufficient response and de novo CIC were the most common reasons for SI. Neither UDS nor questionnaire data were predictive of a single BTX injection. Table 1. Patient Characteristics and Urodynamic Data in BTX Single Injection (SI) vs. Repeat Injection (RI) SI (n=18) RI (n=56) P value Age, yrs, mean ± SD 56.5 ± 14 59.9 ± 18.5 0.42 Gender 0.82 Male, n (%) 5 (27.8%) 15 (26.8%) Female, n (%) 13 (72.2%) 41 (73.2%) Diagnosis 0.0065 NDO, n (%) 10 (55.6%) 49 (87.5%) OAB, n (%) 8 (44.4%) 7 (12.5%) De novo CIC, n (%) 5 (27.8%) 2 (3.6%) 0.0079 % Detrusor Overactivity 68.8% 77.3% 0.52 MCC, mL, mean ± SD 215 ± 173.8 238.5 ± 162.9 0.76 Reflex volume, mL, mean ± SD 136.7 ± 96.7 175 ± 160.6 0.77 pdetMax, cmH2O, mean ± SD 57.5 ± 28.5 52 ± 35.9 0.68 OABq-SF, Score (6-36), mean ± SD 21.1 ± 9.8 24.9 ± 8.4 0.25 PGIS, Score (1-4), mean ± SD 3.6 ± 0.7 3.5 ± 0.7 0.45 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e883 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Rebecca Lavelle More articles by this author Burhan Coskun More articles by this author Gary E. Lemack More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...