Sacral neuromodulation for refractory overactive bladder after prior intravesical onabotulinumtoxinA treatment

Introduction Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT‐A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT‐A injection after the failure of SNM for iOAB. Methods We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT‐A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. Results Seventy‐six patients (62 female) were included. The percentage of success of first BoNT‐A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3‐day bladder diary. Twenty‐eight patients (36.8%) were put under clean intermittent self‐catheterization transitory. After a mean follow‐up of 57.7 (±38.5) months, median number of injections was 2 (1‐15). Overall, 42 patients (55.2%) stopped injections during follow‐up. The estimated 36‐months discontinuation‐free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). Conclusion BoNT‐A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long‐term discontinuation rate.

Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Baron

Perrouin-Verbe

Lacombe³

et al. 2020

“…After 1 year of SNM therapy, 79% (11 of 14) were satisfied. Similarly, Hoag et al retrospectively evaluated 36 OAB patients that underwent FSTLP after previous BTX‐A which was either ineffective (69%) or intolerable (31%) because of retention or AEs. The success rate in these patients was 64% (23 of 36).…”

Section: Failure After Snm and Btx‐a As Treatment For Oabmentioning

confidence: 99%

How can we better manage drug‐resistant OAB/DO? ICI‐RS 2018

Chermansky

Schurch

Rahnama’i

et al. 2019

Aims: Botulinum toxin A (BTX-A), sacral nerve stimulation (SNM), and posterior tibial nerve stimulation (PTNS) are established treatments for idiopathic overactive bladder (OAB) refractory to oral drug therapy. At the ICI-RS meeting in Bristol in 2018 a think tank was convened to address the question of how to better manage drug-resistant OAB/DO (detrusor overactivity).Methods: The think tank conducted a literature review and an expert consensus meeting focusing on the evidence for predicting response and adverse events (AEs) with the current therapies for drug-resistant idiopathic OAB.Results: Several factors have been associated with poor outcomes using BTX-A including increasing age, body mass index, male sex, and frailty. Voiding dysfunction with BTX-A also appears to be more prevalent in those with increasing age, male sex, higher baseline postvoid residual and with poorer contractility as assessed by urodynamic parameters. SNM full implantation appears to be higher with the first stage tined lead placement procedure compared to percutaneous nerve evaluation. Urodynamics do not appear to predict outcomes with SNM. Patients with psychiatric comorbidity are more likely to experience AEs with SNM. Outcomes related to lead positioning and the number of active electrodes are mixed in predicting long term success.Patients with increased daytime frequency and lower first sensation of bladder filling were independent factors associated with success with PTNS.Conclusions: Further research is required to optimize these procedures and to better understand which patients will benefit from the various options available in managing refractory OAB. K E Y W O R D Sbotulinum toxin, percutaneous tibial nerve stimulation, sacral neuromodulation S48 |

Sacral neuromodulation in patients with refractory overactive bladder symptoms after failed Botulinum toxin therapy: Results in a large cohort of patients

Reekmans

Janssen

Vrijens

et al. 2021

Aims Sacral neuromodulation (SNM) and Botulinum toxin A (BoNT‐A) injections are well‐known third‐line treatment options in patients with refractory overactive bladder (OAB). Our aim is to evaluate the success rate of SNM in patients who received prior therapy with BoNT‐A injections. Methods All patients with OAB symptoms referred for SNM between 2006 and 2019 were included. History taking and 3‐day voiding diaries assessed the complaints and suitability for SNM. The success rate of SNM in patients who received prior BoNT‐A was compared with BoNT‐A naive patients. Success was defined as an improvement of 50% or greater in voiding diary parameters. Satisfaction was registered at their most recent visit. Results A total of 263 patients underwent SNM test stimulation, of which 75 (16 male/57 female) received prior BoNT‐A and 188 (46 male/142 female) were BoNT‐A naive. Success rate for SNM in BoNT‐A naive patients was 72.9% and in BoNT‐A patients 66.7% (p = 0.316). Success rate after ≤2 BoNT‐A injections was 68.5%, compared to 61.1% after ≥3 injections (p > 0.05). Success rate in patients perceiving lack of efficacy of BoNT‐A was 67.4% (p > 0.05), subjected to temporary CISC was 73.7% (p > 0.05) and with temporary effect of BoNT‐A was 50% (p > 0.05). In 86% of BoNT‐A patients the system was still activated and used to their satisfaction at their last follow‐up visit (mean FU, 40.70 months). Conclusion SNM in patients with refractory OAB who failed prior BoNT‐A is an excellent approach. The number of injections nor reason of BoNT‐A discontinuation have predictive value for success with SNM.