MP79-09 SAFETY AND EFFICACY OF ONABOTULINUMTOXINA INJECTIONS IN THE SETTING OF SUPRAPUBIC CATHETERS

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2018MP79-09 SAFETY AND EFFICACY OF ONABOTULINUMTOXINA INJECTIONS IN THE SETTING OF SUPRAPUBIC CATHETERS Laura L. Giusto MD, Patricia M. Zahner MD, Jessica C. Lloyd MD, Juan M. Guzman-Negron MD, Shree Agrawal BS, Courtenay K. Moore MD, Raymond R. Rackley MD, Sandip P. Vasavada MD, and Howard B. Goldman MD Laura L. Giusto MDLaura L. Giusto MD More articles by this author , Patricia M. Zahner MDPatricia M. Zahner MD More articles by this author , Jessica C. Lloyd MDJessica C. Lloyd MD More articles by this author , Juan M. Guzman-Negron MDJuan M. Guzman-Negron MD More articles by this author , Shree Agrawal BSShree Agrawal BS More articles by this author , Courtenay K. Moore MDCourtenay K. Moore MD More articles by this author , Raymond R. Rackley MDRaymond R. Rackley MD More articles by this author , Sandip P. Vasavada MDSandip P. Vasavada MD More articles by this author , and Howard B. Goldman MDHoward B. Goldman MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2677AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients with suprapubic tubes (SPTs), complaints of urinary leakage per urethra or around the tube are common, and are often refractory to medical therapy. Intradetrusor onabotulinumtoxinA (BTX-A) injection is considered a "next step" for these patients. However, potential benefit must be balanced with risk factors inherent to patients with indwelling catheters including bacterial colonization and chronic inflammatory changes to bladder mucosa. We assessed the use of intradetrusor BTX-A in the setting of existing or concomitant SPT as a safe way to decrease urinary leakage. METHODS Patients undergoing BTX-A injection with SPT in situ or concomitant SPT placement were retrospectively reviewed with CPT codes. Clinical characteristics were pre-procedure urinalysis and urine culture, peri-procedural use of antibiotics, with outcomes considered as complications (30 day post-procedure urinary tract infection (UTI), bleeding, retention or hospitalization), and degree of perceived improvement. Patient characteristics were assessed by chi-square or t-test analyses and outcomes were assessed by univariable and multivariable logistic regression models. RESULTS Fifty patients underwent BTX-A injection in the setting of SPT, 43 (86%) of whom were female. Mean age was 59 years and mean BMI was 30.1 kg/m2. Common overlapping indications for BTX-A injection were neurogenic bladder (86%) and incontinence (52%). Pre-procedural urine cultures were positive at time of injection among 56% of patients. Nearly all patients received documented peri-procedural antibiotics (96%) and 44% received a post-procedure antibiotic course. Positive preoperative urine culture correlated to increased likelihood of prescribed post-procedure antibiotics (OR: 3.56, p=0.04). Complications occurred in 5 patients (10%), with UTI (4/5) and hematuria (4/5) being most common. One of the patients required re-hospitalization and intravenous antibiotics for their UTI, and another required re-hospitalization for clot evacuation. Following first BTX-A injection, 44 (88%) reported a subjective improvement of reduced leakage and went on to receive an average of 4 BTX-A therapies (p = 0.03). The mean number of BTX-A treatments was 3.26 (range 1-12). CONCLUSIONS Intradetrusor BTX-A injection appears to be safe and efficacious in patients with SPTs, with the most common complication being UTI. This therapy may be considered for diminishing urinary leakage in this challenging-to-manage population. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1083 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Laura L. Giusto MD More articles by this author Patricia M. Zahner MD More articles by this author Jessica C. Lloyd MD More articles by this author Juan M. Guzman-Negron MD More articles by this author Shree Agrawal BS More articles by this author Courtenay K. Moore MD More articles by this author Raymond R. Rackley MD More articles by this author Sandip P. Vasavada MD More articles by this author Howard B. Goldman MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...