SUFU 2018: The Effects of Augmentation Cystoplasty and Botulinum Toxin Use on Patient Reported Bladder Function

Austin, TX ( Dr. Jeremy Myers and colleagues presented a study of 846 spinal cord injury (SCI) patients who perform clean intermittent catheterization (CIC) for bladder management, identified from the Neurogenic Bladder Research Group (NBRG) registry. The study sought to examine the effects of augmentation cystoplasty and botulinum toxin use on patient reported bladder function and interventions, such as intravesical botox injections and augmentation cystoplasty, to determine if these interventions can improve satisfaction among individuals with spinal cord injury performing intermittent catheterization, an attempt to decrease rates of CIC discontinuation.

The authors also sought to compare bladder function and patient satisfaction after these interventions. Individuals were categorized into 3 groups: 1) CIC-alone, 2) CIC with bladder augmentation cystoplasty (AUG), and 3) CIC with botulinum toxin use (BTX). Multivariate linear regression was used controlling for multiple factors to establish differences in the Neurogenic Bladder Symptom Score (NBSS), sub-domains of the NBSS (Incontinence, Storage & Voiding, Consequences), and the final question of the NBSS (satisfaction with urinary function) between the three managements. Mean time from SCI injury was 14 years.

The authors found that current bladder management included CIC-alone in 562 (67%), AUG in 125 (14%), and BTX in 158 (19%). Total NBSS, compared to CIC-alone, showed AUG had improved urinary function (+12%, p<0.001) and no difference in the BTX group. The overall change in the AUG group was driven by improvements in the Incontinence sub-domain where AUG was much better than CIC-alone (+20%, p<0.001). There were no differences between groups in the other NBSS subdomains. Assessing satisfaction with urinary function, compared to CIC-alone, AUG also had better satisfaction (+29%, p<0.001); there was no difference in satisfaction with BTX. 

The authors concluded that augmented patients were better in global continence and function than the other two groups.  A limitation of the study is that the data is cross sectional; the authors cannot conclude that botox doesn’t work, as they don’t have measure of how patients were prior. The study highlights continued research in the field of neurogenic bladder. 

Source of Funding: PCORI CER14092138

Presented by: Jeremy B Myers, MD, FACS¹

Co-Authors: Sara Lenherr MD, MS², John Stoffel MD³, Sean Elliott MD, MS⁴, Angela Presson PhD, MS⁵, Chong Zhang MS⁵, Darshan Patel MD⁵, Amitabh Jha MD, MPH⁵, Jeffrey Rosenbluth MD⁵ and Blayne Welk MD, MSc⁶

Author Information: 
1. University of Utah
2. University of Utah, Salt Lake City, UT
3. University of Michigan, Ann Arbor, MI
4. University of Minnesota, Minneapolis, MN
5. University of Utah, Salt Lake City, UT
6. Western University, London, Ontario, CAN

Written by: Cristina Palmer, DO. Female Urology, Pelvic Reconstruction, Voiding Dysfunction Fellow, Department of Urology, UC Irvine Medical Center, Orange, California at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas