OnabotulinumtoxinA injection to the external urethral sphincter for voiding dysfunction in females: A tertiary centre experience

Seth J1, Trimboli M1, Hamid R1, Ockrim J L1, Greenwell T J1, Pakzad M H1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 356
Open Discussion ePosters
Scientific Open Discussion Session 21
Thursday 30th August 2018
13:50 - 13:55 (ePoster Station 4)
Exhibition Hall
Female Bladder Outlet Obstruction Retrospective Study
1. University College London Hospitals NHS Foundation Trust
Presenter
R

Rizwan Hamid

Links

Poster

Abstract

Hypothesis / aims of study
Treatment options for voiding dysfunction in females are limited. The aim of this study was to examine the functional outcomes of onabotulinumtoxinA injections into the external urethral sphincter (EUS) for voiding dysfunction in females.
Study design, materials and methods
A retrospective analysis of a prospectively kept database was performed, of all patients receiving onabotulinumtoxinA injections at a tertiary centre. Cases were performed from 2015 to 2017, all under general anaesthesia. All patients were evaluated with pre-operative videourodynamic study and urethral pressure profilometry and all received 100U of treatment. All had three months of follow up.
Results
10  female patients  with mean age 45.5 years (18-80years) were identified. 4 had urodynamic evidence of bladder outflow obstruction (2 of which had detrusor sphincter dyssynergia), and 6 had an acontractile detrusor. The mean pre-op mid-urethral closure pressure (MUCP) was 93.3cmH20 (mean expected MUCP was 45). The measured MUCP  was higher than the expected MUCP in all cases. 6 had failed previous Sacral Nerve Stimulation. 4 women were voiding pre-onabotulinumtoxinA, 4 were performing clean intermittent self-catheterisation (CISC), and 2 had an indwelling suprapubic catheter (SPC).
Interpretation of results
After onabotulinumtoxinA, 6 were voiding, 2 were performing CISC, and 2 remained with an SPC. Median pre-op QMax improved from 8.5ml/s to 12.5ml/s, and mean post void residual volume decreased from 244mls to 94mls. 4 patients reported quality of life improvement after treatment, however 1 reported short lived benefit lasting less than 3 months. 2 patients went onto repeat treatments. There were no significant adverse events. 1 patient developed transient stress urinary incontinence after the injection.
Concluding message
OnabotulinumtoxinA to the EUS, is a valid treatment in females with voiding dysfunction, where therapeutic options are limited. The results can be short lived and patients must be made aware of this. Further study is required, with longer term follow up.
Disclosures
Funding Not applicable Clinical Trial No Subjects Human Ethics not Req'd Retrospective study from database Helsinki Yes Informed Consent Yes
28/03/2024 06:29:45