onabotulinumtoxinA Injections Research Articles

Temporary autonomic modulation with botulinum toxin type A to reduce atrial fibrillation after cardiac surgery

Postoperative atrial fibrillation (POAF) frequently complicates cardiac surgery and is associated with worse outcomes. The cardiac autonomic nervous system is implicated in the pathogenesis of POAF. The purpose of this study was to determine the efficacy and safety of selective cardiac autonomic modulation in preventing POAF. In this randomized, double-blind, placebo-controlled trial, adults undergoing cardiac surgery were randomized 1:1 to intraoperative injection of 250 units onabotulinumtoxinA (botulinum toxin type A [BoNTA]) or placebo into epicardial fat pads. The study was powered to detect a 40% reduction in relative risk of POAF. Time to first episode of in-hospital POAF was the primary outcome, evaluated in patients receiving injection. Additionally, incidence of POAF, length of stay (LOS), and adverse events were examined. The trial assigned 145 patients to injection, 15 of whom were dropped before treatment, leaving 130 patients for analysis. Overall, 36.5% (23/63) of BoNTA-treated patients developed POAF compared with 47.8% (32/67) of placebo-treated patients. The time-to-event analysis revealed a hazard ratio of 0.69 (95% confidence interval 0.41-1.19; P = .18) for the BoNTA vs placebo arm. There were no significant differences in postoperative hospital LOS (median [interquartile range] 6.0 [3.4] vs 6.2 [3.7] days; P=.51) or adverse events prolonging LOS (27/63 [42.9%] vs 30/67 [44.8%]; P = .83) in patients receiving BoNTA vs placebo. Epicardial injection of onabotulinumtoxinA was without discernible adverse effects, but we failed to detect a significant difference in risk of POAF. Future large-scale studies of epicardial onabotulinumtoxinA injection as a potential POAF prevention strategy should be designed to study smaller, but clinically meaningful, treatment effects.

7] Efficacy, complications and tolerability of repeated intravesical onabotulinumtoxinA injections in interstitial cystitis/bladder pain syndrome

ObjectiveTo evaluate the outcome, safety, and patient’s tolerability of repeated intravesical onabotulinumtoxinA (BOTOX) injection for interstitial cystitis (IC)/bladder pain syndrome (PBS).

What Is the True Catheterization Rate After Intravesical OnabotulinumtoxinA Injection?

(Abstracted from Int Urogynecol J 2018;29:1005–1009) Intravesical onabotulinumtoxinA (Botox) is widely used for the treatment of urinary urge incontinence and overactive bladder (OAB). One of the most common complications of intravesical onabotulinumtoxinA injection is incomplete bladder emptying requiring clean intermittent catheterization (CIC).

Bladder changes after catheterizable channel creation in adults with cerebral palsy who are in chronic urinary retention

Cerebral palsy (CP) is characterized by motor impairments as a result of brain injury during development. Patients can have neurogenic bladder dysfunction and are often unable to catheterize through their native urethra. Catheterizable channel (CC) creation can facilitate clean intermittent catheterization (CIC). We have observed that patients with large capacity, low-pressure bladders can develop de novo neurogenic detrusor overactivity (NDO) postoperatively. We sought to better characterize this finding. We reviewed the charts of patients 17 years or older with CP seen between 2006 and 2017. Patients undergoing creation of any type of CC without augmentation cystoplasty, due to adequate storage on pre-operative urodynamics (UDS), were included. Pre- and post-operative UDS were reviewed. Frequency of incontinence and use of anticholinergics or intravesical injections of onabotulinum toxin A (Btx) were reviewed. Eight patients with CP underwent CC creation without augmentation. Preoperatively, six of eight patients were in chronic retention with two others performing CIC. Following CC creation, patients in retention required additional NDO management with anticholinergics, mirabegron, or onabotulinumtoxin A. Among those with complete UDS data, 67% demonstrated lower maximum cystometric capacity postoperatively. Median follow-up was 25 months. CC creation facilitates CIC in adults with CP who are in chronic retention due to pseudodyssynergia. Despite preoperative UDS suggesting an adequate capacity, low-pressure bladder, such patients often manifest de novo NDO and worsening incontinence upon initiation of CIC after surgery. These findings should be considered when determining whether to perform augmentation at the time of CC in adults with CP.

Long-Term Outcome of Patients With Intractable Chronic Cluster Headache Treated With Injection of Onabotulinum Toxin A Toward the Sphenopalatine Ganglion - An Observational Study.

ObjectivesTo investigate long‐term outcomes in per‐protocol chronic cluster headache patients (n = 7), 18 and 24 months after participation in “Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache.”MethodsData were collected prospectively through headache diaries, HIT‐6, and open questionnaire forms at 18 and 24 months after the first treatment. Patients had access to repeated injections when needed.ResultsAn overall significant reduction in cluster headache attack frequency per month (57.3 ± 35.6 at baseline vs 12.4 ± 15.2 at month 18 and 24.6 ± 19.2 at month 24) was found. In addition, there was a reduction in attacks with severe and unbearably intensity (50.0 ± 38.3 at baseline vs 10.1 ± 14.7 at month 18 and 16.6 ± 13.7 at month 24) and an increase in attack free days (4.2 ± 5.9 at baseline vs 19.1 ± 9.4 at month 18 and 12.9 ± 8.8 at month 24).ConclusionsOur findings suggest sustained headache relief after repeated onabotulinumtoxinA injections toward the sphenopalatine ganglion in intractable chronic cluster headache. A placebo‐controlled trial with long‐term follow‐up is warranted.

Can Intradetrusor OnabotulinumtoxinA Injections Alter Heart Function in Patients with Cardiac Arrhythmia?

The prevalence of overactive bladder (OAB) increases with age and can be associated with other co-morbidities, such as cardiac arrhythmia. Unfortunately, commonly used anticholinergic drugs for OAB can affect the cardiovascular system, leading to tachycardia. However, there are no data, which consider the influence of intradetrusor onabotulinumtoxinA injections on heart function in idiopathic OAB patients. The aim of the present study was to evaluate the influence of intradetrusor onabotulinumtoxinA injections on electrocardiogram (ECG) parameters. Additionally, changes in ECG were analyzed in OAB patients without cardiac arrhythmia. Thirty-one patients with cardiac arrhythmia and 31 participants without irregular heart rate (HR) completed the study. ECG measurements were performed in supine positions 2 h before onabotulinumtoxinA injections, 1 h after treatment, and at 2 weeks of follow-up. At week 6, a phone-call survey was conducted to collect data about adverse events. OnabotulinumtoxinA injections were performed with rigid cystoscopy under local anesthesia. We did not observe any clinically significant changes in the analyzed ECG parameters between consecutive measurements. While a slight increase of HR was observed in patients without cardiac arrhythmia, it remained within normal range. Intravesical onabotulinumtoxinA injections are, hence, safe for female patients with cardiac arrhythmia and do not significantly influence changes in ECG.

What Is the Role of Additional Pharmacotherapy and Neuromodulation in Patients with Marginal Benefit from Botulinum Toxin Injection?

Third-line therapies for patients with overactive bladder (OAB) can improve symptoms for those who have failed conservative therapies. Options include percutaneous tibial nerve stimulation (PTNS), cystoscopic injection of onabotulinumtoxinA (BTX-A), and sacral neuromodulation (SNM). This paper aims to review the current literature on the treatment of patients with idiopathic OAB who have undergone BTX-A injections and have not responded or have undesirable side effects from the therapy. There are no randomized control trials examining the role of concurrent medical therapy and BTX-A; rather, there are observational studies in the neurogenic population. Furthermore, there are two observational studies on the role of SNM in BTX-A refractory idiopathic OAB patients demonstrating its safety and efficacy. There are many options available to the patient who fails BTX-A. Further research in this specific patient population is necessary to determine why patients have suboptimal responses and to delineate the next step in treatment.

A hypothesis for the mechanism of urine incontinence in patients after radical prostatectomy due to urinary bladder hypertrophy.

Prostate cancer is one of the most common neoplasms in elderly males in Europe and is rapidly becoming a major health burden throughout the world. Radical prostatectomy is a first-line treatment in the case of organ-confined prostate cancer and in selected cases of locally advanced disease. Recent studies have suggested that the urinary bladder wall thickness (BWT) is an important predictor of an overactive bladder (OAB). This article focuses on a hypothesis for the mechanism of urine incontinence in patients after radical prostatectomy due to urinary bladder hypertrophy. To verify the possible influence of changes in the urinary bladder structure on urine incontinence development, we designed an experiment in which patients with prostate cancer were qualified for radical prostatectomy. Our hypothesis that urinary bladder hypertrophy influences urine incontinence development in patients after radical prostatectomy may provide an insight toward the prevention and control of urine incontinence after surgery by oral pharmacotherapy or intravesical onabotulinumtoxinA injections in pre-radical prostatectomy mode.

Does Urodynamics Impact the Outcomes of Third-line Therapy of Refractory OAB (or Refractory Urgency Urinary Incontinence)?

Overactive bladder (OAB) is highly prevalent with increasing age. Conservative management including lifestyle adaptation, controlled fluid intake, and bladder training are considered first-line therapeutic options. Second-line options are medication such as antimuscarinics or beta-3 adrenergic receptor agonists. Therapy refractory patients should be referred to a specialist for further evaluation. It currently remains unclear if patients should undergo routine urodynamic investigation (UDI) before offering third-line therapies like sacral neuromodulation (SNM) or intradetrusor injection of onabotulinumtoxinA (IdetInBotA). The aim of this narrative review was to assess if the presence of detrusor overactivity (DO) can predict treatment success of third-line therapies for OAB. There is only limited evidence available for both IdetInBotA and SNM, but treatment success does not appear to be related to the presence of DO in baseline UDI. Hence, routine UDI is not mandatory in patients with OAB but remains an option when its outcome is likely to change the treatment strategy or to assess the risk of upper urinary tract deterioration.

Injection of Onabotulinum Toxin A into the Bilateral External Oblique Muscle Attenuated Camptocormia: A Prospective Open-Label Study in Six Patients with Parkinson's Disease.

IntroductionCamptocormia (severe bending of the spine) is a debilitating complication of Parkinson’s disease (PD) without established treatment. Botulinum toxin (BT) may be beneficial, but data is scarce regarding the efficacy of administration of BT into the bilateral external oblique (EO) muscle for treatment of camptocormia in PD.MethodsSix patients with PD and camptocormia, with flexion of the thoracic spine, were enrolled in the study. BT (75 or 90 units, onabotulinum toxin A) were injected into each EO bilaterally under sonographic guidance. Camptocormia angle (CA) was defined as the angle between the acromion-greater trochanter line and a vertical line. CA and disabling symptoms were evaluated during the treatment course.ResultsTwo weeks after the injection of BT, the mean CA showed significant attenuation [median (interquartile range); 38° (23.5°) vs. 18° (21°), p = 0.028]. Subjective relief was present in cases 1–3 and 6, and absent in cases 4 and 5. Cases 1–3 received repeated injections to maintain the amelioration; in cases 1 and 2, this was for 1 year or longer, while falls of case 3 limited the amelioration.ConclusionBotulinum therapy into bilateral EO attenuated the angle of thoracic-level camptocormia in six patients with PD over the observation period of 2 weeks. The reproducibility of the results, long-term efficacy, and subjective relief of symptoms require further examination.

Higher Neural Correlates in Multiple Sclerosis Patients with Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA

OnabotulinumtoxinA is a well described treatment of neurogenic overactive bladder. While motor effects on the detrusor muscle have been extensively studied, the sensory effects have not. The aim of this study was to evaluate the impact of intradetrusor onabotulinumtoxinA injection on brain activity in female patients with multiple sclerosis and neurogenic overactive bladder. We prospectively studied 12 women with stable multiple sclerosis and neurogenic overactive bladder using concurrent functional magnetic resonance imaging and urodynamic studies prior to and 6 to 10 weeks following onabotulinumtoxinA injection. Individual functional magnetic resonance imaging activation maps at the time of strong urgency were averaged before and after onabotulinumtoxinA injection where areas of significant activation were identified. After onabotulinumtoxinA injection functional magnetic resonance imaging activation increased in the right cingulate body (p = 0.0012), the left posterior cingulate (p = 0.02), the left anterior cingulate (p = 0.0015), the right prefrontal cortex (p = 0.0015), the insula (p = 0.0138) and the pons micturition center (p = 0.05). Sparse areas showed decreased activity, including the left cerebellum (p = 0.001), the left fusiform gyrus (p = 0.065) and the bilateral lentiform nucleus (p = 0.026). Intradetrusor injection of onabotulinumtoxinA appeared to increase the activity of most brain regions known to be involved in the sensation and process of urinary urgency in female patients with multiple sclerosis and neurogenic overactive bladder. To our knowledge this is the first study of its kind to evaluate the possible effects of onabotulinumtoxinA at the human brain level where sensory awareness is located. This activation pattern may be used to further phenotype patients to optimize therapy or determine the sensory effects of onabotulinumtoxinA beyond the bladder.

Botulinum Toxin for the Treatment of Hand Tremor.

The aim of this study is to review our longitudinal experience with onabotulinumtoxinA (onaBoNT-A) injections for medically refractory hand tremor. We performed a retrospective review of our database of patients treated with onaBoNT-A for hand tremor evaluated between 2010 and 2018 in at least 2 sessions with follow-up. The majority were injected into the forearm flexors (FF), although treatment was individualized. During the specified period, 91 patients (53 essential tremor, 31 dystonic tremor, 6 Parkinson’s disease tremor, and 1 cerebellar outflow tremor) met our inclusion criteria. The mean age (SD) was 64.8 years (12.8), and mean duration of follow-up was 29.6 months (25.1) with mean of 7.7 (6.3) treatment visits. FF were injected in 89 (97.8%) patients, exclusively in 74 (81.3%), and 15 (16.5%) were injected in FF and other muscles. EMG guidance was used in 5 patients (5.5%). On a 0–4 “peak effect” rating scale (0 = no effect, 4 = marked improvement in severity and function), 80.2% and 85.7% of patients reported moderate or marked improvement (score 3 or 4) at their first and last follow-up visit, respectively. There was no statistically significant difference in the outcomes between first and last visit: average “peak effect” rating score (3.2 versus 3.4), “global” rating score (3.0 versus 3.2), latency of response (4.5 versus 3.8 days), and total duration of response (12.7 versus 12.8 weeks), except onaBoNT-A dose (65.0 versus 78.6 U/limb, p = 0.002). Of 1095 limb injections, there were 134 (12.2%) non-disabling and transient (mean 36 days) adverse events (132 limb weakness, 2 pain). OnaBoNT-A injections are safe and effective in the treatment of hand tremor.

Outcomes of Intradetrusor OnabotulinumtoxinA Injection in Adults with Congenital Spinal Dysraphism in Tertiary Transitional Urology Clinic

PurposePublished data regarding intradetrusor injection of onabotulinumtoxinA in adults with congenital spinal dysraphism are scarce. In this study, we retrospectively investigated the outcomes of intradetrusor injection of onabotulinumtoxinA in this setting. Materials and MethodsBilling codes were used to identify 149 patients who underwent onabotulinumtoxinA injection between 2012−2016 at our tertiary transitional urology clinic. Charts were then reviewed to identify patients with congenital spinal dysraphism. ResultsA total of 18 patients with the mean age of 20.76 (±3.03) years at the time of 1st onabotulinumtoxinA injection were identified. All patients had urinary incontinence. Urinary incontinence improved by injection of 200 or 300 U of onabotulinumtoxinA in 81.2% of patients and 63.6% of them became dry (p= 0.023). Mean glomerular filtration rate before and 13.3 (±9) months after treatment was 100.2 (±17.2) and 120.1 (±16.6) mL/min/1.73 m2 respectively (p= 0.41). Baseline hydronephrosis improved in 3 of 4 patients. Repeat urodynamic study after injection was done in 11 patients who did not clinically improve or who had loss of bladder compliance at baseline (29.3 Vs. 67.2 ml/cmH2O). Mean maximum cystometric capacity before and after injection was 310.1 and 380.2 mL (p= 0.045). Mean bladder compliance before and after treatment was 29.2 and 28.7 ml/cmH2O respectively (p= 0.48) in this high risk group. ConclusionsIntradetrusor onabotulinumtoxinA injection may improve refractory urinary incontinence in selected adults with spinal dysraphism. However, despite improvement in maximum cystometric capacity, bladder compliance does not improve following therapy in patients who had loss of compliance at baseline.

Prospective Analysis of the Greater Occipital Nerve Location in Patients Undergoing Occipital Nerve Decompression.

Migraine surgery and onabotulinumtoxinA injections aim to deactivate neurovascular trigger points implicated in chronic headaches. The greater occipital nerve (GON) is a common trigger point. The depth of this nerve has not been previously described. The purpose of this study was to report the intraoperative location, including depth, of the GON in human subjects undergoing migraine surgery. We reviewed records of patients who underwent GON decompression by a single surgeon. Intraoperative measurement of the GON location lateral to midline, inferior to the occipital protuberance, and deep to the skin was collected for 2 previously described positions: where GON (a) enters, "point #2," and (b) exits, "point #3," the semispinalis muscle as it travels from deep to superficial (Plast Reconstr Surg. 2010;126:1563-1572; Plast Reconstr Surg. 2004;113:693-697). Thirty-four subjects (60 nerves) were included. The mean depths of the GON were 20 mm (SD, 4) at point no. 3 and 30 mm (SD, 6) at point no. 2. In 26 subjects who underwent bilateral surgery, there was a difference between right and left nerve position lateral to midline at point no. 3 (P = 0.008). Female sex (P = 0.014) and body mass index of 29 kg/m or less (P < 0.001) were associated with a more superficial GON position. Knowledge of the GON depth (eg, mean of 20 mm where it emerges from the semispinalis muscle) may improve accuracy of procedural treatments for migraines. When performing bilateral interventions, nerve position may differ between sides, particularly with respect to lateral distance from midline. Differences in this study compared with previous anatomic studies may reflect the use of live subjects in a prone position compared with cadaver specimens.

Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease.

To assess the safety and efficacy of intradetrusor onabotulinum toxin A injections for the treatment of overactive bladder (OAB) in patients with Parkinson's disease (PD). All PD patients who underwent intradetrusor injections of onabotulinum toxin A (BoNT-A) for storage symptoms between 2010 and 2017 were included in a retrospective study. A 100 U dose of BoNT-A (Botox®, Allergan Irvine, CA) was used for the first injection in all patients. The primary endpoint was clinical success defined as any subjective improvement in OAB symptoms self-assessed by the patients 4 weeks after the injections. Out of 24 patients analyzed, 19 reported improvement of their OAB symptoms 4 weeks after the first injection (79.2%) with complete resolution of urgency urinary incontinence in seven patients (29.1%; P < 0.001). The average post-void residual (PVR) increased significantly after the first injection from 17.6 to 125.3 mL (P < 0.001). Three of the patients had to start clean intermittent catheterization (CIC) after the first injection (12.5%). Out of 49 injections in total, only five caused incomplete bladder emptying requiring the use of CIC (10.2%). Higher pre-injection PVR was significantly associated with both a lower chance of symptomatic improvement (P = 0.04) and a higher risk of incomplete bladder emptying with institution of CIC (P = 0.047). Intradetrusor injections of BoNT-A 100 U appeared as a safe and effective option in PD patients with OAB symptoms and a low PVR before the injection. Higher preoperative PVR was the strongest predictor of both treatment failure and postoperative urinary retention requiring CIC.

OnabotulinumtoxinA detrusor injection improves female sexual function in women with overactive bladder wet syndrome

ObjectivesThe correlation between changes in sexual function and improvements in LUTD in patients treated with OnabotulinumtoxinA (onaBoNT-A) detrusor injection is unclear and limited only to women with neurogenic OAB. The aim of this study was to evaluate the impact of OnabotulinumtoxinA (onaBoNT-A) injection on sexual function in women undergoing this treatment for idiopathic wet overactive bladder (OAB). Study designThis is a pilot three-center observational study including women affected by idiopathic wet overactive bladder refractory to standard conservative treatments and underwent onaBoNT-A injection. Sexuality was assessed using the Female Sexual Function Index (FSFI). A 3-day voiding diary, OAB screener questionnaire (OAB-S), and the international consultation on incontinence questionnaire short form (ICIQ-sf) were completed before and 3 months after onaBoNT-A injection to evaluate OAB symptoms. ResultsAll the 32 enrolled patients were included for statistical analysis. These patients received 100U of onaBoNT-A. Significant improvement of many FSFI domains was found. Only desire and pain domains had no significant improvements. The FSFI total score showed a significant improvement (P 0.0008). Clinical efficacy has been documented by voiding diaries, OAB-S scores, and ICIQ-sf scores. Correlation between UUI episodes and FSFI total score was statistically significant (r = −0.73; p = 0.04) while no significant correlation was found between the number of micturition and FSFI total score. ConclusionWomen who underwent successful OnaBoNT-A detrusor injection to treat wet OAB, showed an improvement in sexual function due to the significant correlation between the improvement of urinary urge incontinence and a better gratification of sexuality.

Intraoperative Onabotulinumtoxin-A Reduces Postoperative Narcotic and Anticholinergic Requirements After Continent Bladder Reconstruction

To determine if intradetrusor injection of onabotulinumtoxin-A (BTX-A) would reduce postoperative narcotic and anticholinergic requirements in children undergoing open continent bladder reconstruction. After institutional review board approval, we retrospectively reviewed all bladder reconstructions performed. Bladder reconstruction was defined as the following procedures in any combination: bladder neck reconstruction and sling, bladder neck closure, Mitrofanoff, Monti, or bladder augmentation. We identified 15 children who underwent reconstruction with BTX-A injection and compared these with 15 children who did not receive BTX-A. Postoperative narcotic and anticholinergic requirements were recorded as well as length of stay, time to diet, time to return of bowel function, and complications. All medications were converted to morphine mEq/kg per day or mg/kg per day to standardize for patient size and length of stay. Thirty patients who underwent open bladder reconstruction were included. Fifteen received BTX-A injection and 15 did not. The BTX-A group required significantly less narcotic medication postoperatively compared with the no-BTX-A group (0.32 vs 0.85 morphine mEq/kg per day; P = .0002). The BTX-A group also required significantly less anticholinergic medication compared with the no-BTX-A group (0.22 vs 0.88 mg/kg per day; P = .024). There was no significant difference between the groups with respect to length of stay (98.27 vs 9.287 days; P = .34) or return of bowel function (5.53 vs 4.93 days; P = .994). Complication rate between the groups was similar (P >.99). Intraoperative injection of BTX-A significantly reduced postoperative narcotic and anticholinergic requirements in patients who underwent open continent bladder reconstruction. This is an encouraging alternative treatment to manage postoperative pain with no associated risk of significant complications.

Systematic review and practice policy statements on urinary tract infection prevention in adults with spina bifida.

Urinary tract infection (UTI) is a source of morbidity and healthcare costs in adults with spina bifida (ASB). UTI prevention strategies are often recommended, but the evidence of various approaches remains unclear. We performed a systematic review to inform a best practice policy statement for UTI prevention in ASB. On behalf of the Neurogenic Bladder Research Group (NBRG.org), we developed an a priori protocol and searched the published English literature for 30 outcomes questions addressing UTI prevention in ASB. The questions spanned the categories of antibiotics, oral supplements, bladder management factors and social support. Where there was little literature in ASB, we included literature from similar populations with neurogenic bladder (NB). Data was abstracted and then reviewed with recommendations made by consensus of all authors. Level of Evidence (LoE) and Grade of Recommendation (GoR) were according to the Oxford grading system. Of 6,433 articles identified by our search, we included 99 publications. There was sufficient evidence to support use of the following: saline bladder irrigation (LoE 1, GoR B), gentamicin bladder instillation (LoE 3, GoR C), single-use intermittent catheterization (IC) (LoE 2, GoR B), hydrophilic catheters for IC (LoE 2, GoR C), intradetrusor onabotulinumtoxinA injection (LoE 3, GoR C), hyaluronic acid (HA) instillation (LoE 1, GoR B), and care coordination (LoE 3, GoR C). There was sufficient evidence to recommend against use of the following: sterile IC (LoE 1, GoR B), oral antibiotic prophylaxis (LoE 2, GoR B), treatment of asymptomatic bacteriuria (LoE 2, GoR B), cranberry (LoE 2, GoR B), methenamine salts (LoE 1, GoR B), and ascorbic acid (LoE1, GoR B). There was insufficient evidence to make a recommendation for other outcomes. Overall, there are few studies in UTI prevention in the specific population of ASB. Research in populations similar to ASB helps to guide recommendations for UTI prevention in the challenging patient group of ASB. Future studies in UTI prevention specific to ASB are needed and should focus on areas shown to be of benefit in similar populations.

Inconsistency in the Definition of Urinary Tract Infection after Intravesical Botulinum Toxin A Injection: A Systematic Review

To more accurately examine the rate of urinary tract infection following onabotulinumtoxinA injection of the bladder we systematically reviewed the literature for definitions of urinary tract infection in studies of onabotulinumtoxinA injections. We assessed the studies for consistency with guideline statements defining urinary tract infections. We systematically reviewed the literature by querying MEDLINE® and Embase®. We included original studies on adult patients with idiopathic overactive bladder and/or neurogenic detrusor overactivity who underwent cystoscopy with onabotulinumtoxinA injection and in whom urinary tract infection was a reported outcome. We identified 299 publications, of which 50 met study inclusion criteria. In 27 studies (54%) urinary tract infection diagnostic criteria were defined with a total of 10 definitions among these studies. None of the overactive bladder studies used a definition which met the EAU (European Association of Urology) criteria for urinary tract infection. Only 2 of the 10 studies on patients with neurogenic bladder used a urinary tract infection definition consistent with the NIDRR (National Institute on Disability and Rehabilitation Research) standards. Definitions of urinary tract infection are heterogeneous and frequently absent in the literature on onabotulinumtoxinA to treat overactive bladder and/or neurogenic bladder. Given the potential for post-procedure urinary symptoms in this setting, explicit criteria are imperative to establish the true urinary tract infection rate following treatment with onabotulinumtoxinA.

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

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 ...