Pi-Lba01 Sacral Neuromodulation Versus Onabotulinumtoxina for Refractory Overactive Bladder

Abstract

of proximal mesh arms with or without concurrent bladder reconstruction for mesh erosion or concurrent vaginal approach. The DaVinci robotic platform was used to access the space of Retsiuz. Instruments were limited to curved monopolar scissors, fenestrated bipolar forceps, and an assistant port. Mesh arms were located then dissected proximally through the rectus muscle to the subcutaneous tissues of abdominal wall and distally to the periurethral endopelvic space and removed intact.RESULTS: Our patient was on average a 53-year-old female with history of mid-urethral sling. One-half underwent mesh excision for pelvic pain; the other one-half for mesh erosion, five for retropubic and two for transobturator slings. Two underwent retropubic robotic and transvaginal approaches for mesh excision concurrently. One maintained the vaginal portion of her mesh. Four underwent retropubic robotic excision of mesh arms alone as they had had prior vaginal mesh excision. Insufflation of the space of Retzius avoids transabdominal access. The mesh arms are clearly visualized and ultimately completely excised intact. Concurrent pathology including mesh erosion and bladder reconstruction can be addressed. Subjectively, patients have less perioperative discomfort. There were no complications. There was no worsening in pain. All have had at least some improvement in their symptoms with one-half having near resolution.CONCLUSIONS: We present an illustrative index patient treated for pain despite transvaginal excision of mesh, however it is clear that the basic surgical approach is applicable across a variety of pathologies including complications of mesh erosion. In our series, we have had encouraging results. We demonstrate a minimally invasive option for excision of pelvic mesh. The main advantages being magnified optics and enhanced exposure for complete mesh visualization and excision.

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence

“…The use of intradetrusor onabotulinumtoxinA (BTX‐A) injections has been approved by the FDA for use in patients with refractory idiopathic OAB. The ROSETTA Trial (Refractory OAB: Sacral Neuromodulation vs Botulinum Toxin Assessment) is an ongoing RCT comparing SNS versus 200 U BTX‐A in women with refractory OAB . A total of 364 subjects were available for the 6‐month primary outcome analyses with women in the SNS group undergoing a two‐stage procedure.…”

“…The ROSETTA Trial (Refractory OAB: Sacral Neuromodulation vs Botulinum Toxin Assessment) is an ongoing RCT comparing SNS versus 200 U BTX-A in women with refractory OAB. 63 A total of 364 subjects were available for the 6-month primary outcome analyses with women in the SNS group undergoing a twostage procedure. The rate of clinical response, defined as a ≥50% reduction in UUI episodes on a 3-day bladder diary, was similar in the BTX-A and SNS groups (83% versus 84%).…”

Sacral neuromodulation for treatment of overactive bladder: a review

“…The ROSETTA -Refractory Overactive Bladder: Sacral Neuromodulation vs Botulinum Toxin Assessment -trial is a randomized controlled trial designed to compare treatment with 200U of onabotulinumtoxinA (the only BTX-A presentation approved for use in the bladder at the time of the study) injected in the detrusor versus SNM in female patients with refractory OAB 23 . A total of 369 patients were treated after being randomized for both groups.…”