SUFU 2021: The Effect of Stress Urinary Incontinence on Catheterization Rates Following Intradetrusor onabotulinumtoxinA for Urgency Urinary Incontinence

( This was a retrospective chart review conducted between 1/2010 and 12/2019 to determine whether patient-reported stress urinary incontinence (SUI) at the time of intradetrusor onabotulinumtoxinA injections (ONA 100 Units) for urgency urinary incontinence (UUI) had an effect on catheterization rates. Subjects with a diagnosis of neurogenic bladder or baseline catheterization requirements were excluded.

Clean intermittent catheterization (CIC) was at the discretion of the clinician and was typically recommended if the post-void residual volume(PVR)>350mL or < 350 ml with symptoms of incomplete emptying at a follow-up visit. 177 females were included, 72 reported mixed urinary incontinence (MUI) symptoms at the time of ONA, and 105 did not (UUI only). Women with MUI were significantly older (74.5 years [67,80] vs 69 years [61.5,78.5], p=0.02) and demonstrated lower pre-ONA PVRs (12.5ml [0,33.75] vs 24ml [0,55], p=0.04) compared to women with UUI only.

There was no difference in other demographic characteristics, including the proportion of women with prior anti-incontinence procedures (p=0.2) between groups. Post-injection CIC rates were 11.3%. Women with MUI had significantly lower rates of CIC (4.2% vs 16.2%, p=0.015) and lower post-ONA PVRs (49 ml [16.25,129.5] vs 107ml [48.5,199.5], p=0.002) than women with UUI only. The combined subjective improvement or cure rates of UUI symptoms between groups were not different (UUI: 81.0% vs MUI: 84.7%, p=0.52). There was no difference in the proportion of women pursuing subsequent ONA injections between groups (p=0.77). Women with self-reported MUI at the time of ONA demonstrate lower CIC rates than women with UUI only. The authors postulated that lower outlet resistance due to either decreased periurethral support or lower maximum urethral closure pressure among the MUI group may be the reason this group had lower CIC rates or they may be better at emptying with Valsalva.

Presented by: Caroline Brandon, Dominique Malacarne Pape, Cheongeun Oh, Fabiana Kreines, Sameer Thakker, Nirit Rosenblum, Victor Nitti, Benjamin Brucker, Dianne Glass, Department of Urology and Obstetrics-Gynecology, New York University Langone Health, Department of Obstetrics Gynecology, Westchester Medical Center, Department of Population Health, New York University Langone Health, Department of Urology and Obstetrics-Gynecology, University of California Los Angeles, Department of Obstetrics Gynecology, University of Chicago

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting.