Aim:
To compare patients with neurogenic detrusor overactivity treated with botulinum toxin A or augmentation cystoplasty regarding urinary symptom severity, quality of life, satisfaction, and decision regret.

Hypothesis:
Augmentation cystoplasty is associated with superior urinary symptom control and quality of life compared with BTX-A in selected patients with neurogenic detrusor overactivity.

A cross-sectional study was conducted including consecutive adults with neurogenic lower urinary tract dysfunction at a tertiary center. Patients had received botulinum toxin A or augmentation cystoplasty for neurogenic detrusor overactivity within the past 20 years. Participants attended a single study visit including clinical evaluation and validated questionnaires: Neurogenic Bladder Symptom Score (NBSS), WHOQOL-BREF, Qualiveen, Decision Regret Scale, and a satisfaction survey. Demographic and clinical data were recorded, and outcomes were compared between groups.

A total of 216 adults were evaluated (median age 41 years, IQR 31–50; 56.0% men), including 102 who underwent augmentation cystoplasty and 114 treated with botulinum toxin A. The main etiologies of neurogenic lower urinary tract dysfunction were spinal cord injury (31.5%) and myelomeningocele (28.7%). Augmentation cystoplasty yielded significantly better urinary symptom control and quality of life outcomes. Mean NBSS was lower after augmentation cystoplasty than botulinum toxin A (1.09 ± 1.08 vs 2.05 ± 1.30; p < 0.001), with all NBSS domains favoring augmentation cystoplasty (p < 0.001 for all). WHOQOL-BREF physical and social domains were also higher in the augmentation group (p = 0.031 and p = 0.042, respectively). Qualiveen total scores were lower following augmentation cystoplasty (12.7 ± 7.9 vs 18.7 ± 8.3; p < 0.001). Perceived improvement was greater in the augmentation group (84.8 ± 18.3% vs 65.2 ± 24.1%; p < 0.001), and decision regret tended to be lower (11.5 ± 14.0 vs 15.6 ± 15.9; p = 0.052).

Augmentation cystoplasty was associated with superior urinary symptom control and better quality of life compared with botulinum toxin A. Although decision regret was low in both groups, it tended to be lower after augmentation cystoplasty, supporting its role as an effective treatment option for selected patients with neurogenic detrusor overactivity.

Augmentation cystoplasty provides superior symptom control, quality of life, and patient satisfaction compared with BTX-A in selected patients with neurogenic detrusor overactivity, supporting its role as an effective treatment option after BTX-A failure or discontinuation.

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Myers JB, Lenherr SM, Stoffel JT, et al. The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury. Neurourol Urodyn. 2019.