SUFU 2022: A Closer Look: Outcomes of Intradetrusor Injection of OnabotulinumtoxinA (BTX-A) in the Elderly Population.

( The AUA guidelines recommend oral anticholinergics/antimuscarinics and beta-3 adrenergic agonists as second line therapy. There is increasing understanding that oral anticholinergics/antimuscarinics may have been negative cognitive effects and one of the beta-3 adrenergic agonists (mirabegron) may negatively affect the blood pressure in older adults. There is a lack of evidence assessing the outcomes of OnabotulinomtoxinA (BTX-A) injection as a third line OAB therapy, evaluating its efficacy and safety in older adults.

A retrospective chart review of patients (>70 yrs at time of 1st injection) seen at the Urology clinic who underwent intradetrusor BTX-A from May 2015 to September 2021 (n=107, 83% female) was obtained. Baseline characteristics, assessment of overactive bladder symptoms based on self-reported symptoms before and after injection were retrieved.

Prior to injection, 91% (94) were voiding spontaneously. Urinary urgency was the most common symptom in 98.1%, followed by urinary incontinence, daytime frequency in 91% and 83% respectively. The most common medications initially prescribed were anticholinergic (66%), followed by beta-3 adrenergic agonist (26.2%). The amount of BTX-A injected was 100U (88.3%) and 200U (8.7%).

A subgroup analysis by the OAB symptom domain after BTX-A showed that there was a significant improvement in 87% for incontinence, 73% for urinary urgency, 65% for daytime urinary frequency, and 57% for nighttime frequency. De novo intermittent catheterization was initiated in four patients but was temporary and only one needed indwelling catheter placement. 56.3% returned for repeated injections due to good symptom response. Nineteen (20%) had a symptomatic UTI at follow-up and 88% were not needing OAB medications after follow-up.

The authors concluded that BTX-A is well tolerated in patients > 70 yrs with significant improvement in all OAB symptom domains and significant reduction of their oral OAB medication needs, providing an option for older adult patients who have unwanted side effects from oral OAB medications.

Presented by: Natalia Hernandez,1 Lia Miceli,2 Julie N. Stewart,1 Ricardo R. Gonzalez,1 Rose Khavari1

  1. Department of Urology. Houston Methodist Hospital
  2. Department of Urogynecology. Houston Methodist Hospital

Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting, February 22 - 26, 2022