Efficacy of combination therapy of midurethral sling and low-dose Abobotulinumtoxin-A injection in mixed urinary incontinence

Hajebrahimi S1, Shamsi-sisi H2, Jahantabi E2, Salehi-Pourmehr H1, Hashim H3

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 194
On Demand Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction
Scientific Open Discussion Session 17
On-Demand
Mixed Urinary Incontinence Surgery Clinical Trial
1. Research center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran., 2. Urology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran., 3. Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Presenter
S

Sakineh Hajebrahimi

Links

Abstract

Hypothesis / aims of study
Management of mixed urinary incontinence (MUI) is controversial. There are limited number of studies that report on simultaneous treatment approaches. Our primary aim was to determine the outcome of combined trans-obturator tape sling (TOT) and low dose intra- detrusor injection of Abobotulinumtoxin-A (Abobot-A, Dysport®) in women with MUI.
Study design, materials and methods
This was a prospective before-after clinical trial conducted on 50 women who had the symptoms of MUI and were referred to female urology clinic in a teaching hospital. All subjects in the study underwent history taking as well as physical and vaginal examinations, and stress test. The inclusion criteria was women with MUI previously treated with anticholinergic drugs who did not tolerate or responded to oral pharmacotherapy or conservative therapy. All females with severe prolapse, neurogenic disease (multiple sclerosis, spinal cord injury, cerebrovascular accident, etc.), history of intravesical botulinum toxin injection, sacral neuromodulation, and patients with a history of vaginal surgery or any  surgery for urinary incontinence were excluded from the study. For the enrolled MUI patients, after filling the questionnaires, urodynamics study was performed. The patients in the study had positive Valsalva leak point pressures (VLPP) + detrusor overactivity (DO), cough induced DO and normal or average capacity . We requested urine culture for all patients before the interventions and for  symptomatic patients in follow-up.
Under general or local anesthesia we performed cystoscopy using a 19-Fr rigid cystoscope in the lithotomy position. The bladder was filled with 150ml of irrigation fluid and injected 300 U of Abobotulinumtoxin-A in 20 to 30 injection sites intra-detrusor in each patient after reconstituting with 10cc normal saline using a 27 Gauge disposable needle in all the bladder wall, away from the trigone. After that they underwent the TOT procedure procedure.
TOT is a surgical procedure for the treatment of SUI. This method was first described by Delorme (20). The surgical procedure involves using a monofilament polypropelene mesh that passes under the middle of the urethra and through the two holes of the obturator (Boston or KIM).
Results
Before the operation, women with MUI reported worse baseline overall incontinence and OAB symptoms. The mean (SD) age of patients was 52.26 (10.32). The mean score was 17.42 (2.76) for ICIQ-UI-SF and 9.38 (2.77) for ICIQ-OAB prior to the treatment. We followed the patients 12 weeks after intervention. Their mean ICIQ-OAB symptoms decreased  [1.19 (1.02); P<0.001]. The mean score of ICIQ-UI-SF decreased post-intervention, too [1.50 (1.42); P<0.001]. Considering improvement using the PGI-I scale, 46 (92.3%) stated that they had significant subjective improvement of their symptoms. Four patients (7.7%) mentioned a slight degree of improvement of their symptoms.
Interpretation of results
Combination therapy of TOT and 300 U Dysport® was accompanied with a promising effect in the patients with MUI according to the results of standardized questionnaires. However, further studies with controlled arms are recommended.
Concluding message
Combination therapy of TOT and 300 U Dysport® was accompanied with a promising effect in the patients with MUI according to the results of standardized questionnaires. However, further studies with controlled arms are recommended.
Disclosures
Funding Tabriz University of Medical Sciences (Grant No. 60604). Clinical Trial Yes Registration Number IRCT20130306012728N7 RCT No Subjects Human Ethics Committee Tabriz University of Medical Sciences (ethical code: IR.TBZMED.REC.1398.705) Helsinki Yes Informed Consent Yes
16/02/2024 09:51:26