PD27-08 REAL WORLD RETENTION RATES AFTER INTRAVESICAL ONABOTULINUMTOXINA FOR IDIOPATHIC OVERACTIVE BLADDER

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Incontinence - Therapy I1 Apr 2015PD27-08 REAL WORLD RETENTION RATES AFTER INTRAVESICAL ONABOTULINUMTOXINA FOR IDIOPATHIC OVERACTIVE BLADDER Olufenwa Milhouse, Marta Johnson, Leah Gross, and Steven Siegel Olufenwa MilhouseOlufenwa Milhouse More articles by this author , Marta JohnsonMarta Johnson More articles by this author , Leah GrossLeah Gross More articles by this author , and Steven SiegelSteven Siegel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.452AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of idiopathic overactive bladder (OAB) is 12-19%. Among the list of third line therapies include intravesical onabotulinumtoxinA (iBTXA). Analysis from two large phase III clinical trial demonstrated a 6.5% incidence of acute urinary retention (AUR) requiring catheterization (CIC). However, other studies have demonstrated a higher incidence of AUR, ranging from 5-35%. Our primary objective is the incidence of AUR requiring CIC after initial iBTXA for idiopathic OAB and to evaluate factors that may predict AUR after iBTXA. METHODS Medical records were reviewed from patients undergoing initial iBTXA since 2010. Patients with a diagnosis of interstitial cystitis or neurogenic detrusor overactivity (NDO) were excluded. Primary objective was overall incidence of AUR requiring CIC. Factors analyzed by logistic regression to determine association with AUR include age, gender, diagnosis of diabetes, baseline post void residual (PVR), presence of urodynamic detrusor overactivity (DO), bladder capacity, peak flow rate (Qmax), and BTXA dose. RESULTS A total of 292 patients underwent initial iBTXA using between 2010 and 2014. Excluding NDO and those without follow up, 103 patients were analyzed. Overall incidence of CIC was 25.2%. In 5 of these patients, postoperative PVR was < 200 mL; excluding them, the incidence of AUR was 20.4%. Of these, 24% were male versus 21% in non-retention (non-AUR) patients. Diabetics made 24% and 17% of the retention (AUR) and non-AUR group respectively. Mean age, proportion with DO, bladder capacity, and Qmax were similar. Baseline PVR was similar at 30 and 34 mL in the AUR and non-AUR group respectively. The 200unit dose was used in 19% and 11% in the AUR and non-AUR group respectively. Mean postoperative PVR was 269 mL and 80.5 mL in the AUR and non-AUR group respectively. Overall incidence of UTI was 30%; 62% in the AUR versus 22% in the non-AUR group (p = 0.0012). Despite AUR, over 40% of patients continued with a second iBTXA. On logistic regression, no variable was associated with the risk of AUR requiring CIC due to small sample size. CONCLUSIONS Our overall incidence of AUR requiring CIC is 30%. Standardization of AUR definition and further investigation into the specific risk factors are needed to more accurately counsel patients considering iBTXA. Characteristics of Total study population, non-retention and retention groups Characteristic Total population Non-retention Retention P-value No. of patients (%) 103 (100) 82 (79.6) 21 (20.4) Age (years) 68 ± 16 68 ± 16 68 ± 16 0.983 No. male patients (%) 22 (21.4) 17 (20.7) 5 (23.8) 0.7696 Diabetes (%) 19 (18.4) 14 (17.1) 5 (23.8) 0.5311 Bladder capacity (mL) 278 ± 166 278 ± 166 284 ± 170 1.000 Qmax (mL/s) 17 ± 10 17 ± 10 16 ± 11 0.913 No. with Detrusor overactivity (%) 89 (86.4) 57 (69.5) 15 (71.4) 0.8644 Preoperative PVR (mL) 33 ± 36 34 ± 38 30 ± 30 0.614 No of BTXA dose: 200 units (%) 13 (12.6) 9 (11) 4 (19) 0.4595 Postoperative PVR (mL) 115 ± 102 81 ± 76 269 ± 41 < 0.0001 PVR change 89 ± 107 51 ± 80 240 ± 46 < 0.0001 No. of Culture-proven UTI (%) 31 (30) 19 (22.3) 13 (62) 0.0012 Mean± SD © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGinsberg D (2018) OnabotulinumtoxinA is Preferred over Sacral Neuromodulation for Refractory Overactive BladderJournal of Urology, VOL. 197, NO. 1, (11-13), Online publication date: 1-Jan-2017. Volume 193Issue 4SApril 2015Page: e574 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Olufenwa Milhouse More articles by this author Marta Johnson More articles by this author Leah Gross More articles by this author Steven Siegel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...