Austin Health

Title
Sacral neuromodulation for refractory overactive bladder after prior intravesical onabotulinumtoxinA treatment
Publication Date
2016-09-09
Author(s)
Hoag, Nathan
Plagakis, Sophie
Pillay, Samantha
Edwards, Alisa Wilson
Gani, Johan
Subject
Botulinum toxin A
Overactive bladder
Sacral neuromodulation
Urgency urinary incontinence
Type of document
Journal Article
DOI
10.1002/nau.23117
Abstract
AIMS: Sacral neuromodulation (SNM) is a well-established treatment modality for refractory overactive bladder (OAB). There is a paucity of evidence examining the use of SNM in patients who have received prior intravesical onabotulinumtoxinA (BTXA) treatment. We aim to review those patients who underwent SNM for refractory OAB following treatment with BTXA. METHODS: A retrospective review was conducted to identify patients who had undergone prior intradetrusor BTXA for refractory OAB, then subsequent first-stage SNM. Patient demographics, number/dosage of BTXA, voiding diaries, and patient global impression of improvement (PGI-I) scores were recorded. Successful first-stage SNM was defined as subjective patient improvement of greater than 50%. Patient satisfaction and device use at last follow-up was noted. RESULTS: Eighty-three patients were identified having undergone SNM for OAB, of which 36 had prior BTXA treatment and were included in the series. 23/36 (63.9%) of patients had successful first-stage SNM, and underwent insertion of implantable pulse generator, compared to 33/47 (70.2%) in those who had never been treated with BTXA (P = 0.5). Mean PGI-I score was 2.6 (range 1-4). With a mean follow up of 29.1 months (range 12-53), 17/23 (73.9%) were satisfied, and using the device at last follow-up. CONCLUSION: SNM is a suitable treatment option in those patients who have had prior BTXA treatment for refractory OAB, even in those for whom BTXA proved ineffective. Success rates were within the published range, and comparable to our own results, for SNM in OAB patients without prior BTXA treatment.
Link
Citation
Neurourology and Urodynamics 2017; 36(5): 1377-1381
Jornal Title
Neurourology and Urodynamics

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