Video-urodynamic Predictive Factors of Successful Urethral OnabotulinumtoxinA Treatment of Neurogenic or Non-neurogenic Urethral Sphincter Hyperactivity

Lee Y1, Ong H1, Jiang Y1, Jhang J1, Kuo H1

Research Type

Clinical

Abstract Category

Neurourology

Abstract 423
Open Discussion ePosters
Scientific Open Discussion ePoster Session 21
Thursday 30th August 2018
13:15 - 13:20 (ePoster Station 12)
Exhibition Hall
Voiding Dysfunction Pelvic Floor Urodynamics Equipment
1. Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
Presenter
Y

Yu-Khun Lee

Links

Poster

Abstract

Hypothesis / aims of study
This study analyzed treatment outcomes and identified predictive factors for successful urethral onabotulinumtoxinA treatment of voiding dysfunction due to urethral sphincter hyperactivity.
Study design, materials and methods
Patients with voiding dysfunction due to urethral sphincter hyperactivity were retrospectively reviewed. Patients were treated with injections totaling 100 U of onabotulinumtoxinA into the urethral sphincter. Treatment outcomes were assessed 1 month after treatment using the Global Response Assessment. Treatment outcomes were analyzed by demographic and baseline video-urodynamic characteristics.
Results
Of the 95 patients included, good outcomes were reported in 58 (61.1%) patients. Treatment outcome was not related to age, gender, or voiding dysfunction subtype. Patients with good outcomes had a significantly smaller volume at first sensation of filling (p=0.046), greater Pdet (p=0.027), higher Qmax (p=0.017) and smaller PVR (p=0.006). An open bladder neck during voiding was the only predictor of successful therapeutic outcome (88% good outcomes, 12% poor outcomes, p<0.001) (Table 1). Patients with non-neurogenic voiding dysfunction had a significantly longer therapeutic duration than those with neurogenic voiding dysfunction (9.55±4.18 vs 7.44±2.91 months, p=0.033) (Table 2). Increased urinary incontinence was reported in 18 patients, including 6 with stress urinary incontinence and 12 with urgency urinary incontinence.
Interpretation of results
The findings revealed that urethral sphincter onabotulinumtoxinA injection relieved voiding dysfunction in 61.1% of patients regardless of neurogenic or non-neurogenic etiology. Patients who had an open bladder neck on voiding cystourethrography had predictably successful therapeutic results. Patients with early bladder sensation of filling, higher detrusor pressure, higher Qmax, and a smaller PVR volume appeared to benefit more from urethral sphincter onabotulinumtoxinA injection than those with lower bladder contractility.
Concluding message
An open bladder neck may predict a good therapeutic outcome after urethral onabotulinumtoxinA injection, in either neurogenic or non-neurogenic voiding dysfunction.
Figure 1
Figure 2
Disclosures
Funding None Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Research Ethics Committee, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Helsinki Yes Informed Consent Yes