Intravesical onabotulinumtoxinA Injection Research Articles

Predictive Factors for Clean Intermittent Catheterization after Intravesical OnabotulinumtoxinA Injections in Women with Overactive Bladder: a Danish Retrospective Cohort Study.

We aimed to evaluate the clean intermittent catheterization (CIC) rate in women undergoing their first OnabotulinumtoxinA (BTX-A) treatment and to investigate factors predictive of initiating CIC. This was a retrospective cohort of women, who had their first BTX-A treatment for symptoms of overactive bladder (OAB) syndrome, with a pretreatment urodynamic study (UDS). We reviewed demographic, medical and gynecological history, UDS, pretreatment bladder diaries, objective examinations, BTX-A treatment details, and post-void residual (PVR) reports in the electronic medical record. Botox® Allergan 100 International Units were injected into the detrusor at 10-20 sites. Statistical analyses included univariate and multivariate logistic regression analyses. We included 397 women. Median age was 68 (Q1-Q3: 54-76) years. CIC rate was 8.6% (n = 34) following the first BTX-A treatment. Urgency urinary incontinence (UUI) reduced the risk of undergoing CIC (OR 0.30, 95% CI 0.09-0.97). A bladder capacity of 500ml or greater in the bladder diary increased the risk of CIC (OR 2.46, 95% CI 1.06-5.70), whereas reported leakages were associated with a decreased risk of CIC (OR 0.24, 95% CI 0.10-0.57). Multivariate logistic regression analysis showed that anterior colporrhaphy (OR 3.71, 95% CI 1.52-9.06) and 10-ml increments in median maximum cystometric capacity (OR 1.03, 95% CI 1.00-1.06) predicted CIC, whereas UUI was a protective factor for CIC (OR 0.23, 95% CI 0.07-0.79). A history of anterior colporrhaphy, large bladder capacity, and absence of incontinence episodes in bladder diary or UDS were risk factors for CIC after the first BTX-A treatment.

Sexual Dysfunction in Patients with Overactive Bladder Syndrome Treated with Botulinum Toxin

Introduction: Overactive bladder (OAB) is a syndrome of the lower urinary tract characterized by urinary urgency, frequency, and nocturia, with or without urgency urinary incontinence. OAB significantly impacts all aspects of life—social, psychological, physical, professional, domestic, and sexual—for both women and men. The aim of this study was to investigate sexual dysfunction in both women and men with OAB treated with intravesical onabotulinumtoxinA (Botox) injections using the Sexual Quality of Life questionnaire in two versions: female (SQoL-F) and male (SQoL-M). Methods: Forty sexually active patients (thirty women and ten men) with idiopathic OAB were recruited. Patients completed the SQoL-F or SQoL-M questionnaire before treatment, and again at 3 and 6 months after treatment with intravesical onabotulinumtoxinA injections. Results: All 40 patients completed the study (30 women and 10 men). There were no statistically significant differences in SQoL results before the procedure or at 3- and 6-months post-treatment. Conclusions: OAB treatment with onabotulinumtoxinA did not significantly affect the quality of sexual life in either women or men. Further research is needed using questionnaires specifically designed to assess the sexual life of patients with OAB, especially in men.

173 - Predictive factors for clean intermittent catheterization after intravesical onabotulinumtoxinA injections in women with overactive bladder syndrome: A Danish retrospective cohort study

173 - Predictive factors for clean intermittent catheterization after intravesical onabotulinumtoxinA injections in women with overactive bladder syndrome: A Danish retrospective cohort study

Adverse Effects of Intravesical OnabotulinumtoxinA Injection in Patients with Idiopathic Overactive Bladder or Neurogenic Detrusor Overactivity: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

Despite the efficacy of onabotulinumtoxinA, its safety profile remains a concern. This meta-analysis reviewed the major adverse events (AEs) associated with intravesical onabotulinumtoxinA treatment in patients with neurogenic detrusor overactivity (NDO) and idiopathic overactive bladder (iOAB). Randomized controlled trials (RCTs) conducted between January 2000 and December 2022 were searched for adult patients administered different onabotulinumtoxinA dosages or onabotulinumtoxinA vs. placebo. Quality assessment was performed using the Cochrane Collaboration tool, and statistical analysis was performed using Review Manager version 5.3. A total of 26 RCTs were included in the analysis, including 8 on NDO and 18 on iOAB. OnabotulinumtoxinA vs. placebo significantly increased the urinary tract infection (UTI) incidence in patients with NDO (relative risk, or RR, 1.54) and iOAB (RR, 2.53). No difference in the RR with different onabotulinumtoxinA dosages was noted. Urinary retention was frequent with onabotulinumtoxinA use in the NDO (RR, 6.56) and iOAB (RR, 7.32) groups. Similar observations were made regarding the risks of de novo clean intermittent catheterization (CIC). The risk of voiding difficulty increased with onabotulinumtoxinA use in patients with iOAB. Systemic AEs of onabotulinumtoxinA, including muscle weakness (RR, 2.79) and nausea (RR, 3.15), were noted in patients with NDO; most systemic AEs had a low incidence and were sporadic.

Efficacy and Safety of Low-Dose Intravesical OnabotulinumtoxinA Injections in Female Patients With Detrusor Overactivity With Detrusor Underactivity.

We assessed the effectiveness and safety of using intravesical onabotulinumtoxinA (onabotA; BOTOX) injection with a low dose (75 units) for treating urinary storage symptoms in patients with detrusor overactivity with detrusor underactivity (DODU) compared to using the standard 100 units of onabotA in patients with overactive bladder (OAB). This ambidirectional study included 121 female patients who received intravesical onabotA injections at our hospitals. A total of 87 patients with OAB and 34 patients with DODU were reviewed using a 3-day voiding diary, uroflowmetry, and questionnaires including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, and Patient Perception of Bladder Condition. Patients were evaluated at baseline, within 2 weeks of treatment, and beyond 3 months after treatment. Questionnaire scores of the DODU group demonstrated significant improvement in the short term, with a subsequent decline, but an overall improvement compared to baseline in the long term. Notably, the DODU group exhibited enhanced IPSS voiding scores after the treatment. In the OAB group, most questionnaire scores, excluding the IPSS voiding score, showed significant posttreatment improvement, which was sustained to some extent in the long term. Voiding diary parameters related to storage symptoms were enhanced in both groups. The maximum and mean flow rates decreased in the OAB group but increased in the DODU group, particularly in the short term (P=0.000). The postvoid residual volume increased in both groups after posttreatment, with a mitigated change in the long term. Safety assessments revealed manageable adverse events in both groups with comparable frequencies. Low-dose intravesical onabotA for DODU demonstrated a relatively shorter duration of efficacy than OAB. Nonetheless, the treatment improved both storage and voiding symptoms in patients with DODU without significant adverse effects.

Shifts in patient preference of third-line overactive bladder therapy after introduction of the implantable tibial nerve stimulator.

Third-line therapies for overactive bladder (OAB) that are currently recommended include intravesical Onabotulinumtoxin-A injections (BTX-A), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The implantable tibial nerve stimulator (ITNS) is a novel therapy that is now available to patients with OAB. The objective of this study was to analyze shifts in patient preference of third-line therapies for OAB after introducing ITNS as an option amongthe previously established therapies for non-neurogenic OAB. A survey was designed and distributed via SurveyMonkey to the platform's audience of U.S. adults of age 18 and older. Screening questions were asked to include only subjectswho reported symptoms of OAB. Descriptions of current AUA/SUFU guideline-approved third-line therapies (BTX-A, PTNS, and SNM) were provided, and participants were asked to rank these therapies in order of preference (stage A). Subsequently, ITNS was introduced with a description, and participants were then asked to rank their preferences amongst current guideline-approved therapies and ITNS (stage B). Absolute and relative changes in therapy preferences between stage A and stage B were calculated. Associations between ultimate therapy choice in stage B and participant characteristics were analyzed. A total of 485 participants completed the survey (62.5% female). The mean age was 49.1 ± 36.5 years (SD). The most common OAB symptoms reported were urgency urinary incontinence (UUI) (73.0%) and urinary urgency (68.0%). 29.2% of patients had tried medication for OAB in the past, and 8.0%-10.3% of patients were previously treated with a third-line therapy for OAB. In stage A, participants ranked their first choice of third-line therapy as follows: 28% BTX-A, 27% PTNS, and 13.8% SNM. 26.6% of participants chose no therapy, and 4.5% chose all three equally. In stage B, participants ranked their first choice as follows: 27.6% BTX-A, 19.2% PTNS, 7.8% SNM, and 19.2% ITNS. 21.9% of participants chose no therapy and 4.3% chose all four equally as their first choice. There were both absolute and relative declines in proportions of patients interested in BTX-A, SNM, and PTNS as their first choice of third-line therapy with the introduction of ITNS. Patients originally interested in PTNS in stage A had the greatest absolute change after the introduction of ITNS with 7.8% of participants opting for ITNS in stage B. Those interested in SNM in stage A had the largest relative change in interest, with 43.5% of those originally interested in SNM opting for ITNS in stage B. Finally, with the introduction of ITNS, the number of participants initially not interested in any third-line therapy declined by an absolute change of 4.7% and relative change of 17.6%. Participants experiencing concurrent stress urinary incontinence (SUI) symptomswere more likely to choose a current guideline-approved third-line therapy than ITNS or no therapy at all (p = 0.047). Those who had prior experience with third-line therapies were more likely to choose a third-line therapy other than ITNS as their ultimate choice of therapy in stage B. Of those who had chosen a guideline-approvedthird-line therapy in stage B (not ITNS), 13.6% had prior experience with BTX-A, 14.7% with PTNS, and 32 (11.2%) with SNM (p < 0.001, p < 0.001, p = 0.009, respectively). From our study, it appears that ITNS may attract a subset of patients who would not have otherwise pursued current guideline-approved third-line therapies for OAB. When patients are provided with descriptions of third-line OAB therapies including ITNS as an option, ITNS appears to compete with SNM and PTNS. It is possible that ITNS will provide patients with a different phenotype of neuromodulation therapy that can appeal to a niche OAB population. Given that ITNS devices have been introduced relativelyrecently to the market, their application will largely depend on cost and payer coverage, provider bias, and patient comorbidities. Further study is needed to understand how these factors interact with and influence patient preference of advanced OAB therapy to understand which patients will most benefit from this treatment modality.

Bleeding risk in female patients undergoing intravesical injection of onabotulinumtoxinA for overactive bladder: a Danish retrospective cohort study

Introduction and hypothesisWe aimed to examine the risk of bleeding in female patients undergoing intravesical onabotulinumtoxinA (BTX-A) treatments and provide clinical recommendations for the perioperative management of patients on antithrombotic therapy prior to BTX-A treatments.MethodsThis was a retrospective cohort of Danish female patients, who had their first BTX-A treatment because of an overactive bladder at the Department of Gynecology and Obstetrics, Herlev and Gentofte University Hospital, between January 2015 and December 2020. Data extraction was from an electronic medical journal system. BTX-A, Botox® Allergan was injected in the detrusor at 10–20 sites. Significant bleeding during or after a BTX-A treatment was defined as persistent macroscopic hematuria. Bleeding reporting was based on information obtained from journal notes.ResultsWe included 400 female patients, who had a total of 1,059 BTX-A treatments. Median age at first BTX-A treatment was 70 years (IQR 21), and median number of BTX-A treatments was 2 (range 1–11). In total, 27.8% (n=111) received antithrombotic therapy. Within this group, 30.6% and 69.4% were on anticoagulant and antiplatelet therapy. No cases of hematuria were reported in our cohort. We found that no patients stopped their antithrombotic therapy, were bridged, or monitored by International Normalized Ration (INR) levels.ConclusionsWe suggest that BTX-A treatments might be classified as low-risk procedures. Discontinuation of antithrombotic therapy is not required in the perioperative management of this patient group.

MP37-20 INTRAVESICAL BLADDER ONABOTULINUMTOXINA: INVESTIGATION OF PATIENT RESPONSE AND TREATMENT DOSE OVER TIME

You have accessJournal of UrologyCME1 Apr 2023MP37-20 INTRAVESICAL BLADDER ONABOTULINUMTOXINA: INVESTIGATION OF PATIENT RESPONSE AND TREATMENT DOSE OVER TIME Clarissa Niino, Kai Dallas, Poone Shoureshi, Alexandra Dubinskaya, and Karyn Eilber Clarissa NiinoClarissa Niino More articles by this author , Kai DallasKai Dallas More articles by this author , Poone ShoureshiPoone Shoureshi More articles by this author , Alexandra DubinskayaAlexandra Dubinskaya More articles by this author , and Karyn EilberKaryn Eilber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical onabotulinumtoxinA is a third-line therapy option for treatment of overactive bladder (OAB), with an average response of 6 months, sustained over 36 months, based on initial trials. However, these studies did not address increases in onabotulinumtoxinA dose over time for progression of disease. The objective of this study was to determine patient factors that are associated with increased onabotulinumtoxinA dose over time. METHODS: After IRB approval, a retrospective chart review was performed of all patients who received onabotulinumtoxinA treatments in a female pelvic medicine and reconstructive urology practice between January 2010 and July 2021. Patients were identified using CPT procedure code 52287 and data was extracted. Data reviewed included age, gender, race, BMI, smoking history, type of incontinence, surgical history, menopausal status, hormone replacement therapy use, number and dose of onabotulinumtoxinA treatments, time between treatments, and prior OAB therapies (type of medication, neuromodulation). Outcomes measured included duration of response and a dose escalation at the second or third onabotulinumtoxinA injection. Univariate comparisons were performed with the chi-square test and T-Test for categorical and continuous variables. Multivariate analysis was performed with logistic regression modeling. RESULTS: A total of 209 patients received intravesical onabotulinumtoxinA injections during the study. Mean age was 73 years. 147 (70.3%) patients underwent more than one treatment. 46 (22.0%) patients were found to have 0-6 months between the first and second treatments, 58 (27.8%) patients had 6-12 months between treatments, and 45 (21.5%) patients had over 12 months between treatments. There were no significant associations between any factors and response time; however, patient age less than 60 (56.2% vs. 26.0%, p=0.01) and dual medical therapy (35.7% vs 22.5%, p=0.04) were both associated with a dose escalation. Both factors remained significant under multivariable analysis. CONCLUSIONS: In our cohort, patients who were younger or receiving dual medical therapy were significantly more likely to have their onabotulinumtoxinA dose increased. Over the course of treatment, no significant difference was found in patient response in the setting of increasing doses. Thus, increased dosage of onabotulinumtoxinA did not directly correlate with response. This information can be used when counseling patients as to post-procedure expectations. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e522 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clarissa Niino More articles by this author Kai Dallas More articles by this author Poone Shoureshi More articles by this author Alexandra Dubinskaya More articles by this author Karyn Eilber More articles by this author Expand All Advertisement PDF downloadLoading ...

The Correlation of Diabetes Mellitus and Urinary Retention From Intravesical OnabotulinumtoxinA Injection for Overactive Bladder.

The objective was to determine whether patients with diabetes mellitus (DM) treated with intravesical onabotulinumtoxinA (BoNT) injection for overactive bladder (OAB) had increased urinary retention requiring clean intermittent catheterization (CIC), as well as the impact of disease duration and severity. We hypothesize that patients with DM will have higher rates of retention after BoNT injection. We performed a retrospective cohort analysis of women in the Kaiser Permanente Southern California Health System who underwent BoNT injection for OAB, excluding women with a history of urinary retention or neurogenic bladder. We identified 565 patients, 410 in the control group and 155 in the DM group. No significant difference was found in the rate of CIC (9% in the control group versus 5.8% in the DM group, P = 0.2), voiding dysfunction, and peak postprocedure postvoid residual volume (PVR). Patients with diabetes had a significantly increased rate of postprocedure urinary tract infection (UTI; 27.6% versus 38.1%, P = 0.02). Urinary tract infection was significantly associated with urinary retention (adjusted odds ratio [OR], 2.26; 95% confidence interval [CI], 1.02-4.99; P = 0.045) and peak PVR ≥200 mL (adjusted OR, 2.42; 95% CI, 1.15-5.06; P = 0.019). Diabetic disease duration and severity were not a predictor of urinary retention, elevated PVR, or voiding dysfunction; however, the presence of ≥1 disease-related complication was a predictor of UTI (adjusted OR, 2.81; 95% CI, 1.34-5.91; P = 0.006). Diabetic patients had a similar rate of urinary retention requiring CIC after BoNT injection for OAB compared with nondiabetic patients. Diabetic patients had an increased risk of UTI based on disease severity.

Are we underestimating urinary retention following intravesical onabotulinumtoxinA in women with overactive bladder and a history of prior pelvic surgery?

This study's purpose is to review the rates of urinary retention requiring intermittent catheterization (IC) post intravesical OnabotulinumtoxinA (BTN/A) injection for idiopathic overactive bladder from a single practicing specialist urological surgeon. We performed a retrospective review of a single Australian urologist to identify the rate of intermittent catheterization in our clinical setting. Logistic regression was used to assess associations between requirement of IC and risk factors for urinary retention. Ninety-fourpatients were included after inclusion and exclusion criteria were applied and the average age was 69.7 years (SD 17.2) and all participants were female. Thirty-six percent (n = 34) of patients required IC. Of patients requiring IC, 32% had a prior urethral sling, 35% had prior vaginal prolapse surgery, and 29% had a preoperative urinary tract infection(UTI). There was strong evidence of univariate associations between IC and prior sling (odds ratio [OR]: 5.26, 95% confidence interval [CI]: 1.64-16.55, p = 0.005), preoperative UTI (OR: 4.25, 95%CI: 1.31-13.08, p = 0.016) and prior vaginal prolapse surgery (OR: 4.91, 95%CI: 1.64-14.72, p = 0.005). Evidence that prior sling patients were more likely to require IC remained strong in a multivariable model (OR: 7.35, 95% CI: 1.59-34.11, p = 0.011). Prior urethral sling surgery, prior vaginal prolapse surgery, and positive preoperative UTI, despite treatment, were found to be associated with a higher rate of initiation of intermittent catheterization. The rate of IC initiation of 36% was higher than reported in prior clinical trials.

A Feasibility Study to Evaluate Changes in Urinary Metabolites after OnabotulinumtoxinA Injection for Refractory Overactive Bladder.

Metabolomics analysis of urine before and after overactive bladder (OAB) treatment may demonstrate a unique molecular profile, allowing predictions of responses to treatment. This feasibility study aimed to correlate changes in urinary metabolome with changes in OAB symptoms after intravesical onabotulinumtoxinA (BTX-A) injections for refractory OAB. Women 18 years or older with non-neurogenic refractory OAB were recruited to complete OAB-V8 questionnaires and submit urine samples before and after 100 units intravesical BTX-A injection. Samples were submitted to CE-TOFMS metabolomics profiling. Data were expressed as percent of change from pre-treatment and were correlated with OAB-V8 score improvement. Urinary metabolite changes in the OAB-V8 groups were compared using the Kruskal–Wallis test, and associations between metabolites and OAB-V8 scores were examined using quantile regression analysis. Of 61 urinary metabolites commonly detected before and after BTX-A, there was a statistically significant decrease in adenosine and an increase in N8-acetylspermidine and guanidinoacetic acid levels associated with OAB score improvement, suggesting that intravesical BTX-A injection modifies the urinary metabolome. These urinary metabolites could provide insight into OAB pathophysiology and help identify patients who would benefit most from chemodenervation.

Impact of Duration of Antibiotic Prophylaxis on Incidence of UTI after OnabotulinumtoxinA Injection

ObjectiveTo assess the impact of duration of antibiotic prophylaxis on incidence of urinary tract infection (UTI) after intravesical OnabotulinumtoxinA (BTX) injection. MethodsA retrospective cohort study of patients with overactive bladder who underwent office BTX injections from 2014 to 2020. UTI incidence within 30 days of BTX was compared between 3 durations of antibiotic prophylaxis: no antibiotic, single day, or multiple day course. Association of UTI with units of BTX, body mass index, history of diabetes, immunosuppression, neurogenic overactive bladder, chronic catheter, or recurrent UTI were investigated. ResultsTwo hundred ninety patients and 896 cycles of BTX injections were included: 877 injections (97.7%) were women, with mean age 61.4 years (range 20-96; SD 13.3). No antibiotic prophylaxis was given to 112 (12.5%) patients, 595 (66%) received a single day, and 189 (21%) received a multiple day regimen (3-7 days). Overall incidence of UTI within 30 days was 11.4%. On multivariable logistic regression, use of any antibiotic prophylaxis was associated with a lower incidence of UTI (single odds ratio [OR] 0.34; 95% confidence interval [CI] 0.19-0.61; P < .001; multiple OR 0.47; 95% CI 0.24-0.92; P = .029), with no difference between single and multiple day regimens (OR 1.38; 95% CI 0.80-2.38; P = .249). History of recurrent UTI (OR 3.77; 95% CI 2.23-6.39; P < .001) and chronic suprapubic catheter (OR 2.88; 95% CI 1.04-7.95; P = .041) were additional predictors. ConclusionA multiple day regimen of antibiotic prophylaxis was not more effective than a single day in preventing UTI for intravesical BTX injection. Use of any antibiotic prophylaxis was associated with a significantly lower incidence of UTI compared to no antibiotic.

MP01-04 DIFFERENCES IN SURGICAL TREATMENT OF DE NOVO URGE INCONTINENCE OCCURRING POST-HOLMIUM LASER ENUCLEATION OF THE PROSTATE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-04 DIFFERENCES IN SURGICAL TREATMENT OF DE NOVO URGE INCONTINENCE OCCURRING POST-HOLMIUM LASER ENUCLEATION OF THE PROSTATE Lucas Richards, Bristol Whiles, Diego Mazzotti, and Kerri Thurmon Lucas RichardsLucas Richards More articles by this author , Bristol WhilesBristol Whiles More articles by this author , Diego MazzottiDiego Mazzotti More articles by this author , and Kerri ThurmonKerri Thurmon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is an effective option for patients with lower urinary tract symptoms secondary to benign prostate hyperplasia. Although HoLEP has well-established and durable outcomes, it carries a risk of iatrogenic urinary incontinence. Most patients with de novo urge incontinence (UI) experience transient symptoms with resolution rather quickly, but some patients have persistent incontinence. Due to its relative rarity, patient factors that increase the risk of post-HoLEP persistent UI requiring surgical treatment have not been examined. In this study, we identify management options for persistent UI after HoLEP and examine patient risk factors for the condition. Furthermore, we examine symptom response to three surgical treatment options for de novo UI post-HoLEP. METHODS: A retrospective study was performed to identify patients who underwent HoLEP at a single institution between 2016 and 2019. Patient demographics including age, BMI, race, smoking status, history of previous procedures, diabetes, erectile dysfunction, UTI, and pelvic floor physical therapy were evaluated. Prescriptions for alpha blockers, 5-alpha reductase inhibitors, anticholinergic agents, and beta-3 agonists were also identified. Bidirectional stepwise regression was performed using the history of a surgical treatment for UI as the outcome. These procedures include intravesical onabotulinumtoxinA (Botox) injection, peripheral tibial nerve stimulation (PTNS), or sacral neuromodulation (SNM). AUA symptom and quality of life scores were compared in patients with persistent UI that progressed to surgical treatment to those that did not. RESULTS: A total of 340 patients underwent HoLEP during the study period. We evaluated 28 possible risk factors for persistent UI requiring surgical management. Eight (2.4%) patients received one of the third line therapies, with 1 receiving PTNS, 6 receiving SNM alone, and 1 receiving both SNM and Botox. Our current model suggests that a history of UTI prior to HoLEP procedure increases the odds of developing the UI outcome by 36.98-fold; 95% CI [2.75, 496.90]; p=0.006. CONCLUSIONS: Although persistent UI after HoLEP is rare, its management and associated risk factors are important to understand. Prior UTI is associated with increased risk of post-HoLEP UI. These are preliminary results and future studies are needed to further investigate risk factors for persistent UI post-HoLEP as well as compare outcomes for management options. Source of Funding: Presenting author is a trainee supported by TL1TR002368 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e2-e2 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lucas Richards More articles by this author Bristol Whiles More articles by this author Diego Mazzotti More articles by this author Kerri Thurmon More articles by this author Expand All Advertisement Loading ...

Multifocal bladder nephrogenic adenoma following repeated intravesical onabotulinumtoxinA (Botox®) injection for refractory overactive bladder. Case report and literature review

Multifocal bladder nephrogenic adenoma following repeated intravesical onabotulinumtoxinA (Botox^®) injection for refractory overactive bladder. Case report and literature review

Adding mirabegron after intravesical onabotulinumtoxinA injection improves therapeutic effects in patients with refractory overactive bladder.

To investigate whether adding an anticholinergic or beta-3 agonist can improve the therapeutic effect of intravesical onabotuliumtoxinA injection in patients with refractory overactive bladder (OAB). Ninety OAB patients who received an intravesical 100-U onabotulinumtoxinA injection 1 month previously were consecutively invited into a prospective, randomized, open-label study. They were randomly adding on solifenacin 5 mg daily (QD) (30 patients), mirabegron 50 mg QD (31 patients), or no medication (29 patients, control). All enrolled patients completed a 3-day voiding diary, Overactive Bladder Symptom Score (OABSS) and Urgency Severity Scale (USS) questionnaires, Global Response Assessment (GRA) scale, and uroflowmetry at baseline (1 month after intravesical onabotulinumtoxinA injection) and 3-, 6-, 9-, and 12-month follow-up. The primary end point was the effective therapeutic outcome defined as no OAB wet during the 12-month period. The secondary end point included changes of GRA, OABSS, and the parameters of the voiding diary at 3 months. The baseline data were comparable among the three groups. The percentage of OAB wet in the mirabegron-added-on group was significantly less than that in the solifenacin-added-on and onabotulinumtoxinA-only groups at four different time points (P=.02). At 3 months, the changes of GRA, OABSS, USS, urge urinary incontinence, frequency, nocturia episodes, and functional bladder capacity in the mirabegron-added-on group were significantly greater than those in the other groups. No serious adverse events were reported. Adding mirabegron could increase the therapeutic effects, mainly on OAB symptoms and GRA scale, after intravesical onabotulinumtoxinA injection in refractory OAB patients.

Routine Office Assessment After OnabotulinumtoxinA Injection for Overactive Bladder Is Unnecessary to Detect Clinically Significant Voiding Dysfunction.

This study aimed to determine if routine assessment of patients after onabotulinumtoxinA injections for overactive bladder is necessary to detect clinically significant voiding dysfunction. This retrospective cross-sectional cohort study analyzed patients who underwent intravesical injection of onabotulinumtoxinA for overactive bladder during a 4-year period. Patients were included for analysis if they returned for an office follow-up visit within 1 month of administration. Baseline demographic data; procedural details; postvoid residual volumes; abnormal postprocedure voiding symptoms, including urinary frequency, pain, or inability to void; urinary tract infections; and initiation of intermittent self-catheterization were recorded. Descriptive statistics, point-biserial and Pearson correlation analyses were performed. Two hundred thirty-seven injections were included in our analysis. Fifteen encounters, from 13 patients, required the initiation of intermittent self-catheterization (6.3%). The median postvoid residual in those treated with intermittent self-catheterization was 300 mL (min, max: 200, 750 mL); all had received 100 units of onabotulinumtoxinA. The most common symptom among those requiring intermittent self-catheterization was urgency (n = 13; 87%), whereas 93% (n = 14) had at least 1 bothersome symptom. Correlation analyses showed a weak positive correlation with elevated postvoid residual volume and a history of prolapse repair (r = 0.269, P = 0.004), and prior pelvic surgery (r = 0.205, P = 0.029). Clinically relevant urinary retention that required intermittent self-catheterization after onabotulinumtoxinA injection for overactive bladder occurred in 6.3% of participants in this sample. The vast majority of patients who required intermittent self-catheterization described symptoms that they were able to self-identify.

Aşırı Aktif Mesane Tedavisinde Kullanılan İntravezikal OnabotulinumtoksinA Enjeksiyonunun Kadın Cinsel Fonksiyonu Üzerindeki Etkisi: Gözlemsel Çalışma

Aşırı Aktif Mesane Tedavisinde Kullanılan İntravezikal OnabotulinumtoksinA Enjeksiyonunun Kadın Cinsel Fonksiyonu Üzerindeki Etkisi: Gözlemsel Çalışma

Management of urinary incontinence in postmenopausal women: An EMAS clinical guide

IntroductionThe prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. AimThe aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women. Materials and methodsLiterature review and consensus of expert opinion. Summary recommendationsHealthcare professionals should consider urinary incontinence a clinical priority and develop appropriate diagnostic skills. They should be able to identify and manage any relevant modifiable factors that could alleviate the condition. A wide range of treatment options is available. First-line management includes lifestyle and behavioral modification, pelvic floor exercises and bladder training. Estrogens and other pharmacological interventions are helpful in the treatment of urgency incontinence that does not respond to conservative measures. Third-line therapies (e.g. sacral neuromodulation, intravesical onabotulinum toxin-A injections and posterior tibial nerve stimulation) are useful in selected patients with refractory urge incontinence. Surgery should be considered in postmenopausal women with stress incontinence. Midurethral slings, including retropubic and transobturator approaches, are safe and effective and should be offered.

Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery

BackgroundEvidence regarding long-term results in male idiopathic overactive bladder (iOAB) patients is limited and rarely focuses on the effects of prior prostatic surgery. ObjectiveThis study aims to identify the long-term treatment persistency and occurrence of adverse events of intravesical onabotulinum toxin-A (BoNT-A) injections in male iOAB patients after prostatic surgery (ie, transurethral resection of the prostate [TURP] or radical prostatectomy [RP]) compared with surgery-naïve patients. Design, setting, and participantsIn this retrospective, single-centre study, data from 477 patients treated with intravesical BoNT-A injections were collected. Outcome measurements and statistical analysisOutcome data of 120 male patients with iOAB, with collectively 207 BoNT-A injections, were analysed and presented in this study. Results and limitationsAt the last point of follow-up, 35 patients (29.2%) were still on active treatment. Twenty patients (16.7%) required de novo clean intermittent self-catheterisation (CISC). Three groups were identified: 56 patients without prostate surgery, 40 patients with TURP, and 24 patients with RP prior to treatment. Discontinuation rates and patient-reported outcomes of BoNT-A treatment (none, insufficient, or satisfactory) were similar, but a significant difference was seen in de novo CISC (p=0.004): 28.6% in the group without prior surgery, 7.5% in the TURP subgroup, and 4.2% in the RP subgroup. Odds of de novo CISC was significantly higher for the group without prior surgery than for both the TURP subgroup (odds ratio [OR] 4.9; 95% confidence interval [CI]: 1.33–18.31; p=0.017) and the RP subgroup (OR 9.2; 95% CI: 1.14–73.96; p= 0.037). ConclusionsThe data of this retrospective, single-centre cohort suggest that BoNT-A treatment leads to lower CISC rates in male patients after prior desobstructive surgery than in surgery-naïve patients. Patient summaryThis study describes the results of onabotulinum toxin-A (BoNT-A) injections in the bladder of male patients with idiopathic overactive bladder after initial prostate surgery compared with surgery-naïve patients. The results showed that BoNT-A treatment leads to lower catheterisation rates in patients after prior prostate surgery than in men without prior prostate surgery.

Botulinum toxin for overactive bladder

Idiopathic overactive bladder (OAB) is defined as asymptom complex characterized by urinary urgency with or without urinary incontinence, nycturia and increased frequency of micturition without the presence of an infection or other pathological conditions, especially a neurological disease. It is a diagnosis by exclusion. If conservative treatment with behavioral therapy and pelvic floor muscle training alone is not successful, pharmaceutical treatment is recommended according to the OAB staged treatment. For treatment refractory OAB, intravesical injection of onabotulinum toxinA is recommended according to the current guidelines (recommendation levelA). The approved dose is 100U botulinum toxin and is transurethrally injected into the detrusor muscle. The treatment effect lasts on average for 6-9 months and injections can be repeated without limitations. Due to the low rate of complications, the good success rate and the low invasiveness, botulinum toxin offers agood treatment option for treatment refractory OAB.