SUFU 2020: Evaluation of Independent Predictors of Compliance to Continued Therapy With Intradetrusor Botox Injection

Scottsdale, Arizona ( Through a retrospective review of patients who underwent Botox injections, Dr. Gary Lemack and his team examined demographic and urodynamic factors that would be predictive of continuing therapy. The study dates took place between December 2007 to September 2016 as there is a paucity of literature examining predictors for continuing therapy with intradetrusor injections of onabotulinum toxin A (Botox) for refractory urgency/urge incontinence (U/UI).

The authors considered ‘continuation of therapy’ if the patient was treated for over one year and received three or more Botox treatments. Patients were instructed to continue treatments only if they perceived significant benefit. We excluded patients with history genitourinary malignancy, genitourinary fistula/malformation or previous bladder augmentation. We examined pre-injection demographics, co-morbidities, medications, ambulatory status, bladder management, voiding/urodynamic parameters, and Botox dosage. Multivariate logistic regression was used to identify independent predictors of continuing Botox therapy.

A total of 941 injections were done over the study period. Of the 201 patients who underwent a Botox injection, 95 (45%) met our criteria for continued therapy. The average age of our entire cohort at first injection was 54.7±17.1 years, average BMI was 26.23±6.3, with 143 (71%) being female. At the time of injection, 87 patients (41.4%) were on an anticholinergic medication. Regarding bladder management, 94 patients (46.8%) were voiding, with 90 (44.8%) requiring clean intermittent catheterization (CIC) and 16 (8%) using an indwelling catheter. There were 58 patients (27.4%) diagnosed with idiopathic overactivity (iOAB), among those patients diagnosed with neurogenic overactivity (nOAB), 60 (28.3%) had a spinal cord injury, 59 (27.8%) had a diagnosis of either multiple sclerosis or transverse myelitis. On univariate analysis, Botox dosage and a diagnosis of nOAB were predictive of continuing therapy. On multivariate analysis, only a diagnosis of nOAB was a significant predictor of continuing Botox therapy. There were no urodynamic or symptom score predictors of continuing therapy (Table 1). No specific neurological diagnosis was associated with continuing therapy. The mean duration of treatment for those who continued therapy was 4.0±2.7 years.

The researchers concluded that there appears to be an appreciable attrition rate with continuing Botox therapy. A diagnosis of nOAB has been shown to be predictive of continuing Botox therapy.

univariate and multivariate logistic regression analysis

Presented by: Ramy Goueli, MD, MHS, Dayron Rodriguez, MD, MPH, Jonathan Hong, BS, Maude Carmel, MD, Gary Lemack, MD, Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; Twitter: @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - 29, 2020, Scottsdale, AZ