Impact of intravesical onabotulinumtoxinA on sexual function in women with OAB: Beyond the Abstract

The most bothersome symptom of lower urinary tract symptoms (LUTS) is urgency incontinence, which can decrease patients’ quality of life. A range of population-based studies have demonstrated that overactive bladder (OAB) symptoms have a profound negative impact on patients’ sexual health.

The aim of this study was to investigate the effect of intravesical onabotulinumtoxinA (Botox) injection on sexual function in women with OAB, using the multi domain Female Sexual Function Index (FSFI) questionnaire. Sixty-eight sexually active women with idiopathic OAB with at least one episode of UUI and ≥8 micturitions per 24 h were recruited. Patients completed the FSFI questionnaire before and 12 weeks after treatment with intravesical onabotulinumtoxinA injections. Baseline scores were compared with a control group of age-matched healthy women. Fifty-six women completed the study. At baseline OAB patients reported decreased quality of sexual function in all domains measured with FSFI, in comparison to healthy women (median 21.8 vs. 26.3, P < 0.001). At week 12 over 90% of participants reported clinically relevant improvements in sexual function, with statistically significant changes in mean scores in all six domains. Intravesical Botox injections provide improvement in sexual function in women with OAB. 

We have observed the increase of total FSFI index in patients with improvement<50% in urgency urinary incontinence, improvement≥50% and totally cured- 1.42±1.25, 1.77±1.13 and 1.88±1.41, respectively. The results of total FSFI scores in control group and completely dry women after treatment were 26.5±6.2 and 23.8±2.9, respectively (p=0.042). However, there were no statistically significant differences between groups due to relatively small number of patients. Therefore we cannot conclude that decrease in UUI directly lead to improvement in FSFI scores. To achieve appropriate power calculation for such analysis we need a larger study group, the best option would be multicenter study. Our results are applicable for sexually active women with OAB wet; there is still a need for future studies, which will include women sexually inactive at baseline.

Written by: Pawel Miotla, MD PhD

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