Outcomes of Onabotulinumtoxin A injection into the external urethral sphincter for voiding dysfunction in females
BAUS ePoster online library. Nadeem M. 06/21/21; 319091; p5-3
Disclosure(s): Nothing to declare
Ms. Mehwash Nadeem
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Abstract
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Objective:
To assess the functional outcomes of onabotulinumtoxin A(Botox A) injection into the external urethral sphincter(EUS) for voiding dysfunction(VD) due to detrusor underactivity(DU), detrusor acontractility(DA) or high-tone non-relaxing sphincter(HTNRS) in females.
Material and Methods:
A retrospective analysis of a prospectively maintained database was performed assessing all 34 women of mean age 37.6(18-72) years with HTNRS (maximal urethral closure pressure(MUCP) > 92 – age in years), DU or DA receiving their first EUS Botox A injection between Jan 2015 and Nov 2019. All were evaluated with pre-operative videourodynamics(VUDS) and urethral pressure profilometry(UPP) and all received 100U Botox A. All had maximum free flow(QMax), post void residual (PVR) and PGI-I (Patient global impression of improvement) Scale measurement at 3 months post-injection. Median follow up was 18 months.
Results:
Outcomes are detailed in the table.
On multivariate analysis patients with high pre-operative MUCP (> 100 cmH2O) were more likely to have improved Q Max (P= 0.0054), reduction in the need to CISC (P= 0.047), and reduction in PVR (P= 0.006). However, MUCP value cannot predict the likelihood of subjective improvement (p-value= 0.11).
Conclusion:
Botox A injection to the EUS in women with VD due to HTNS or DA is a valid treatment option considering therapeutic options are limited with a 70% response rate and a significant reduction in the need to CISC. However due to the short duration of benefit and the need for repeat treatments long-term continuation occurs in only 9%.
To assess the functional outcomes of onabotulinumtoxin A(Botox A) injection into the external urethral sphincter(EUS) for voiding dysfunction(VD) due to detrusor underactivity(DU), detrusor acontractility(DA) or high-tone non-relaxing sphincter(HTNRS) in females.
Material and Methods:
A retrospective analysis of a prospectively maintained database was performed assessing all 34 women of mean age 37.6(18-72) years with HTNRS (maximal urethral closure pressure(MUCP) > 92 – age in years), DU or DA receiving their first EUS Botox A injection between Jan 2015 and Nov 2019. All were evaluated with pre-operative videourodynamics(VUDS) and urethral pressure profilometry(UPP) and all received 100U Botox A. All had maximum free flow(QMax), post void residual (PVR) and PGI-I (Patient global impression of improvement) Scale measurement at 3 months post-injection. Median follow up was 18 months.
Results:
Outcomes are detailed in the table.
On multivariate analysis patients with high pre-operative MUCP (> 100 cmH2O) were more likely to have improved Q Max (P= 0.0054), reduction in the need to CISC (P= 0.047), and reduction in PVR (P= 0.006). However, MUCP value cannot predict the likelihood of subjective improvement (p-value= 0.11).
Conclusion:
Botox A injection to the EUS in women with VD due to HTNS or DA is a valid treatment option considering therapeutic options are limited with a 70% response rate and a significant reduction in the need to CISC. However due to the short duration of benefit and the need for repeat treatments long-term continuation occurs in only 9%.
Objective:
To assess the functional outcomes of onabotulinumtoxin A(Botox A) injection into the external urethral sphincter(EUS) for voiding dysfunction(VD) due to detrusor underactivity(DU), detrusor acontractility(DA) or high-tone non-relaxing sphincter(HTNRS) in females.
Material and Methods:
A retrospective analysis of a prospectively maintained database was performed assessing all 34 women of mean age 37.6(18-72) years with HTNRS (maximal urethral closure pressure(MUCP) > 92 – age in years), DU or DA receiving their first EUS Botox A injection between Jan 2015 and Nov 2019. All were evaluated with pre-operative videourodynamics(VUDS) and urethral pressure profilometry(UPP) and all received 100U Botox A. All had maximum free flow(QMax), post void residual (PVR) and PGI-I (Patient global impression of improvement) Scale measurement at 3 months post-injection. Median follow up was 18 months.
Results:
Outcomes are detailed in the table.
On multivariate analysis patients with high pre-operative MUCP (> 100 cmH2O) were more likely to have improved Q Max (P= 0.0054), reduction in the need to CISC (P= 0.047), and reduction in PVR (P= 0.006). However, MUCP value cannot predict the likelihood of subjective improvement (p-value= 0.11).
Conclusion:
Botox A injection to the EUS in women with VD due to HTNS or DA is a valid treatment option considering therapeutic options are limited with a 70% response rate and a significant reduction in the need to CISC. However due to the short duration of benefit and the need for repeat treatments long-term continuation occurs in only 9%.
To assess the functional outcomes of onabotulinumtoxin A(Botox A) injection into the external urethral sphincter(EUS) for voiding dysfunction(VD) due to detrusor underactivity(DU), detrusor acontractility(DA) or high-tone non-relaxing sphincter(HTNRS) in females.
Material and Methods:
A retrospective analysis of a prospectively maintained database was performed assessing all 34 women of mean age 37.6(18-72) years with HTNRS (maximal urethral closure pressure(MUCP) > 92 – age in years), DU or DA receiving their first EUS Botox A injection between Jan 2015 and Nov 2019. All were evaluated with pre-operative videourodynamics(VUDS) and urethral pressure profilometry(UPP) and all received 100U Botox A. All had maximum free flow(QMax), post void residual (PVR) and PGI-I (Patient global impression of improvement) Scale measurement at 3 months post-injection. Median follow up was 18 months.
Results:
Outcomes are detailed in the table.
On multivariate analysis patients with high pre-operative MUCP (> 100 cmH2O) were more likely to have improved Q Max (P= 0.0054), reduction in the need to CISC (P= 0.047), and reduction in PVR (P= 0.006). However, MUCP value cannot predict the likelihood of subjective improvement (p-value= 0.11).
Conclusion:
Botox A injection to the EUS in women with VD due to HTNS or DA is a valid treatment option considering therapeutic options are limited with a 70% response rate and a significant reduction in the need to CISC. However due to the short duration of benefit and the need for repeat treatments long-term continuation occurs in only 9%.
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