Previously published literature has estimated that approximately 16.5% of American adults have OAB, and up to 37% of OAB patients have concomitant urinary incontinence (OAB-wet). In fact, OAB is one the most common urologic disorders, accounting for more than 2 million physician office visits in the United States (2007). Nonneurogenic OAB is a symptom complex, which is defined by the International Continence Society standardization committee as urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of proven infection or other obvious pathology. Urgency with at least one other symptom is essential to diagnose OAB and is the cornerstone component of OAB. To date, there is a paucity of validated instruments to define urinary urgency, and therefore, the diagnosis of OAB is based on patient symptomatology. Diagnosis does not rely on urodynamic findings or characteristics and therefore a thorough history and physical examination are essential. Treatment for this nonsurgical condition is therefore aimed toward symptom control. This review provides the reader with a better understanding of the voiding cycle and available medical treatment options for nonneurogenic overactive bladder (OAB). This review contains 11 figures, 7 tables, and 90 references. Key Words: anticholinergic, β3 agonist, botulinum toxin, chemodenervation, cialis, intradetrusor onabotulinumtoxinA, micturation cycle, mirabegron, overactive bladder, phosphodiesterase type 5 inhibitors, urinary retention
Introduction: According to the most recent AUA/SUFU guidelines, intradetrusor onabotulinumtoxinA (BTN/A) is a standard, evidence strength grade B, third line treatment option for refractory non-neurogenic overactive bladder (OAB). Urinary retention is the most common clinically significant reported side effect ranging from 5.4% to 43% in previous studies. The aim of this study was to investigate the real-time rate of urinary retention in patients treated with BTN/A for refractory non-neurogenic OAB in a multi-institutional study. Methods: Retrospective chart review identified 71 patients who were treated with 100U BTN/A for refractory non-neurogenic OAB from August 2011 to July 2015 at two institutions. Using a flexible cystoscope, 100U Botox ® reconstituted with 10 ml normal saline was administered. Injections of 1 ml (10 units/ mL) were administered in 10 evenly distributed sites sparing the trigone. Pre and post BTN/A post-void residuals (PVR) were reviewed. Urinary retention was defined as PVR > 200 mL requiring clean intermittent catheterization (CIC). Results: After exclusion, the study group consisted of 66 patients with a mean age of 67 years and 30% were men. Mean pre and post-procedural PVR were 14.06 mL and 69.21 mL. Eight patients (12.12%) were noted to have elevated PVR > 200 mL post injection however only one patient (female) required initiation of CIC. The rate of urinary retention was 1.5% (N = 1). There was no correlation with age, history of previous radiation, diabetes or prior use of a neuromodulator device. Conclusions: To the best of our knowledge, this is the first study to demonstrate a very low risk of real-time urinary retention rates in appropriately selected patients treated with BTN/A for refractory non-neurogenic OAB outside of a clinical trial setting.
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