Treatment of refractory overactive bladder with OnabotulinumtoxinA vs PTNS: TROOP trial.

We hypothesized that patients with refractory overactive bladder (rOAB) have similar improvement with percutaneous tibial nerve stimulation (PTNS) and OnabotulinumtoxinA (BTX).

This multicenter cohort study compared BTX and PTNS in women with rOAB. Baseline information included Overactive Bladder Questionnaire (OABq) short form, Urinary Distress Inventory-6 (UDI-6), and voiding diary. Primary outcome was cure, defined as "very much better" or "much better" on the Patient Global Impression of Improvement (PGII) AND a reduction in OABq symptom severity scale (SSS) ≥10 at 3 months after treatment. Assuming 80% power to detect a ten-point difference in OABq-SSS, 80 participants were required per group.

A total of 150 patients were enrolled; 97 completed 3 months of therapy and were included. At baseline, BTX patients had more detrusor overactivity (70% vs 40%, p = 0.025), urgency incontinence (UUI; OABq-SSS#6 4 vs 3, p = 0.02, SSS 65 vs 56, p = 0.04), but similar health-related quality of life (HRQL 49 vs 54, p = 0.28), voids (7 vs 8, p = 0.13), and UUI episodes (2 vs 2, p = 1.0). At 3 months, cure rates were similar: BTX 50% vs PTNS 44.2% (p = 0.56). Both groups had improved SSS (-37 vs -29, p = 0.08) and HRQL (31 vs 24, p = 0.14). Patients receiving BTX had a greater improvement in urgency (ΔOABq-SSS#2-3 vs -2; p = 0.02) and UUI (ΔOABq-SSS#6-2 vs -1; p = 0.02). No characteristics were predictive of cure.

BTX resulted in significantly greater improvement in urgency and UUI than PTNS, but no difference in success based on PGII and OABq-SSS, which may be due to a lack of power.

International urogynecology journal. 2022 Jan 07 [Epub ahead of print]

Katelyn Smithling Kopcsay, Tara Doyle Marczak, Peter C Jeppson, Anne P Cameron, Rose Khavari, Eshetu Tefera, Robert E Gutman

Obstetrics & Gynecology, Division of Urogynecology, Baystate Health, 759 Chestnut St, S1681, Springfield, MA, 01199, USA. ., Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Mount Auburn Hospital/Beth Israel Deaconess Medical Center, Boston, MA, USA., Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of New Mexico, Albuquerque, NM, USA., Urology, Division of Neurourology and Pelvic Reconstruction, University of Michigan, Ann Arbor, MI, USA., Urology, Houston Methodist Hospital, Houston, TX, USA., Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, MD, USA., Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Georgetown University/MedStar Washington Hospital Center, Washington, DC, USA.

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