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Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: Do we need urodynamic investigation for outcome assessment

BJU International Aug 18, 2017

Koschorke M, et al. – This study was undertaken to investigate whether urinary continence after intradetrusor onabotulinumtoxinA injections is sufficient for appropriate outcome assessment or if urodynamic investigation (UDI) is required. It was suggested that urinary continence is not sufficient for outcome assessment after intradetrusor onabotulinumtoxinA injections, since high intravesical pressures threatening the upper urinary tract might be missed in a relevant percentage of continent patients. Thus, they strongly recommend UDI as a routine part of the follow–up.

Methods
  • Researchers prospectively assessed a consecutive series of 148 patients undergoing intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) incontinence.
  • Thereafter, patients underwent UDI prior and 6 weeks after onabotulinumtoxinA injections.
  • Preliminary ndpoint was the prevalence of maximum storage detrusor pressure >40 cmH2O in continent patients 6 weeks after treatment.
  • Treatment impacts on other clinical and video-urodynamic parameters were considered as secondary outcomes.

Results
  • It was noted that 6 weeks after intradetrusor onabotulinumtoxinA injections, 98 (66%) of the 148 patients with NDO incontinence became continent
  • In context of the finding, 18 (18%, confidence interval 12-27%) had a maximum storage detrusor pressure >40cmH2O among these patients,.
  • It was revealed that gender, underlying neurological disorder and high storage detrusor pressures prior to treatment seem to increase the risk for poor urodynamic outcomes.
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