Botulinum toxin (OnabotulinumtoxinA) in the male non‐neurogenic overactive bladder: clinical and quality of life outcomes

Habashy, David; Losco, Giuseppe; Tse, Vincent; Collins, Ruth; Chan, Lewis

doi:10.1111/bju.13110

Cited by 27 publications

(34 citation statements)

References 20 publications

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“…Lower CISC rates, in addition to the lower discontinuation rate for the RP subgroup, could mean that BoNT-A treatment is more tolerable for patients with prior RP (as is true for desobstructive surgery). This favourable outcome for the RP subgroup corresponds to the findings of Habashy et al [12], where patients who had undergone RP prior to BoNT-A treatment showed the greatest subjective improvement in urinary symptoms, as well as a statistically significant reduction in pad usage. Another study conducted by Rahnama'i et al [10] compared four subgroups: iOAB without surgery, neurogenic OAB, post-TURP OAB, and post-RP OAB.…”

Section: Discussionsupporting

confidence: 86%

“…Multiple studies suggest that several differences exist between iOAB subgroups, depending on whether the patients underwent prostate surgery prior to BoNT-A treatment. Habashy et al [12] studied clinical improvement in continence after BoNT-A treatment in three subgroups (no prostate surgery, TURP, and RP) and found a significant improvement only in the RP subgroup. In addition, even on a histopathological level, persistent detrusor overactivity following TURP seems to be associated with increased vascular resistance of the bladder vessels and decreased perfusion [13].…”

Section: Introductionmentioning

confidence: 99%

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Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery

Bels

Vries

Beij

et al. 2021

European Urology Focus

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Background: Evidence regarding long-term results in male idiopathic overactive bladder (iOAB) patients is limited and rarely focuses on the effects of prior prostatic surgery. Objective: This study aims to identify the long-term treatment persistency and occurrence of adverse events of intravesical onabotulinum toxin-A (BoNT-A) injections in male iOAB patients after prostatic surgery (ie, transurethral resection of the prostate [TURP] or radical prostatectomy [RP]) compared with surgery-naïve patients. Design, setting, and participants: In this retrospective, single-centre study, data from 477?patients treated with intravesical BoNT-A injections were collected. Outcome measurements and statistical analysis: Outcome data of 120?male patients with iOAB, with collectively 207?BoNT-A injections, were analysed and presented in this study. Results and limitations: At the last point of follow-up, 35?patients (29.2%) were still on active treatment. Twenty patients (16.7%) required de novo clean intermittent selfcatheterisation (CISC). Three groups were identified: 56?patients without prostate surgery, 40?patients with TURP, and 24?patients with RP prior to treatment. Discontinuation rates and patient-reported outcomes of BoNT-A treatment (none, insufficient, or satisfactory) were similar, but a significant difference was seen in de novo CISC (p = 0.004): 28.6% in the group without prior surgery, 7.5% in the TURP subgroup, and 4.2% in the RP subgroup. Odds of de novo CISC was significantly higher for the group without prior surgery than for both the TURP subgroup (odds ratio [OR] 4.9; 95% confidence interval [CI]: 1.33-18.31; p = 0.017) and the RP subgroup (OR 9.2; 95% CI: 1.14-73.96; p = 0.037). Conclusions: The data of this retrospective, single-centre cohort suggest that BoNT-A treatment leads to lower CISC rates in male patients after prior desobstructive surgery than in surgery-naïve patients. Patient summary: This study describes the results of onabotulinum toxin-A (BoNT-A) injections in the bladder of male patients with idiopathic overactive bladder after initial prostate surgery compared with surgery-naïve patients. The results showed that BoNT-A treatment leads to lower catheterisation rates in patients after prior prostate surgery than in men without prior prostate surgery.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery

Bels

Vries

Beij

et al. 2021

European Urology Focus

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“…Intravesical injection with BoNT-A is a well-established treatment for overactive bladder syndrome (8,9). Many studies focus on treatment efficacy and follow-up of patients who were successfully treated.…”

Section: Discussionmentioning

confidence: 99%

Treatment Failure of Botulinum Toxin A in Patients with Idiopathic Overactive Bladder: Why Do Patients Discontinue Treatment?

et al. 2017

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Objectives: The study aimed to evaluate the long-term compliance and reasons for discontinuation of intravesical botulinum toxin A (BoNT-A) treatment in women with idiopathic overactive bladder syndrome (iOAB). Methods: All patients who had been treated with BoNT-A between 2004 and 2010 were invited to join a written survey in June, 2015. Only women with idiopathic OAB symptoms were included. The survey was designed first to assess current urinary symptoms in patients who failed BoNT-A treatment, and second to evaluate their experiences with BoNT-A and subsequent treatments. Results: In total, 74 patients who discontinued BTX-A treatment were identified. The response rate was 62%. The most common reasons for discontinuation of treatment were insufficient effect (37%), the need for clean intermittent self-catheterization (CISC, 13%), and urinary tract infections (UTI, 9%). 17% of the patients reported that they did not want a new treatment despite good effects. After an average follow-up of 92 months, more than three quarters (76%) of the patients suffered from urgency incontinence. In most patients, incontinence had a great influence on daily life (average score of 7 on a scale of 10). During the time of this survey, 25% of the patients used drugs for their OAB symptoms, 15% were referred for sacral neuromodulation, and 1 patient underwent urinary deviation. Conclusions: Our study provides important information on the follow-up and the reasons for discontinuation in patients with idiopathic OAB. This information can be used in counselling of patients and further improvement of BoNT-A treatment.

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“…Habashy et al reported intravesical BoNT-A injection for 43 men with non-neurogenic OAB, including 20 (47%) who had prior prostate surgery, of whom 11 had RP and nine had TURP [ 25 ]. Men with a history of prior prostate surgery had similar Patients’ Global Impression of Improvement (PGI-I) scores to those without prior prostate surgery (2.6 ± 0.5 vs. 2.8 ± 0.5, respectively, p = 0.6).…”

Section: Prior Prostate Surgerymentioning

confidence: 99%

“…The authors concluded that intravesical BoNT-A injection in men with OAB symptoms that are refractory to oral medication can achieve significant symptom improvement despite a history of prior prostate surgery. Nonetheless, those with a history of prior RP benefited more than those with a history of prior TURP in both daily pad use and PGI-I score [ 25 ]. Considering AEs after intravesical BoNT-A injection, Kuo et al .…”

Section: Prior Prostate Surgerymentioning

confidence: 99%

Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Patients with Frailty, Medical Comorbidities or Prior Lower Urinary Tract Surgery

Liao

Wang

Jiang

2016

Toxins

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Overactive bladder (OAB) symptoms increase with age and involve several comorbidities. OnabotulinumtoxinA (BoNT-A) intravesical injection is a treatment choice for patients who are intolerant of or refractory to antimuscarinics. However, the increased risk of urinary tract infection and elevated post-void residual (PVR) volume post-treatment require resolution. Male sex, baseline PVR > 100 mL, and comorbidities are independent risk factors of adverse events (AEs) such as acute urinary retention (AUR). Intravesical BoNT-A injection is safe and effective for OAB patients with frailty, medical comorbidities such as Parkinson’s disease (PD), chronic cerebrovascular accidents (CVA), dementia, or diabetes, or a history of prior lower urinary tract surgery (prostate or transvaginal sling surgery). Post-treatment, 60% of frail elderly patients had a PVR volume > 150 mL and 11% had AUR. Although intravesical BoNT-A injection is safe for PD patients, CVA patients had higher strain voiding rates. Diabetic patients were at increased risk of large PVR urine volume and general weakness post-treatment. Treatment results were similar between patients with and without a history of prostate or transvaginal sling surgery. Possible AEs and bladder management strategies should be conveyed to patients before treatment. Careful patient selection is important, and therapeutic safety and efficacy should be carefully balanced.

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Botulinum toxin (OnabotulinumtoxinA) in the male non‐neurogenic overactive bladder: clinical and quality of life outcomes

Cited by 27 publications

References 20 publications

Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery

Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery

Treatment Failure of Botulinum Toxin A in Patients with Idiopathic Overactive Bladder: Why Do Patients Discontinue Treatment?

Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Patients with Frailty, Medical Comorbidities or Prior Lower Urinary Tract Surgery

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