Abstract: PD26-12
Sources of Funding: None

Introduction

Intradetrusor OnabotulinumtoxinA (ONA) is frequently used to treat urgency urinary incontinence. One possible side effect is incomplete bladder emptying requiring the temporary use of clean intermittent catheterization (CIC). The goal of this study is to examine if patient reported stress urinary incontinence (SUI) had an effect on the rate of CIC.

Methods

A retrospective chart review of patients receiving ONA in the New York University Urology faculty practice between 5/2010 and 9/2016 were reviewed. Unique subjects were identified by CPT and/or J codes for intradetrusor injection of ONA. Charts were reviewed for demographic information, past medical and surgical history, symptoms of SUI (patients with SUI had urgency predominate mixed incontinence), post void residual (PVR) before and after first ONA infection and if catheterization was required after their first ONA injection. Subjects with a diagnosis of neurogenic bladder or a history Multiple Sclerosis, Parkinson’s disease, Cerebral Vascular Accident with residual deficits, Spinal Cord injury, spinal surgery, urethral stricture, baseline catheterization requirement, or prior anti-incontinence surgery were excluded from the analysis. In general, CIC was recommended for patients with a PVR 200-349 ml with symptoms or for a PVR ? 350 ml with or without symptoms. The association between SUI and the need CIC after ONA was examined using a Fischer’s Exact Test.

Results

265 charts were identified as having undergone intradetrusor ONA injection. A total of 115 subjects were are included in the analysis. Subject age at the time of injection ranged from 20-95 years with a mean age of 67.0 +/- 17.2 years. Subjects with SUI had a mean age of 72.6 +/- 10.1 years. 61.7% of subjects were female. Subjects with and without SUI had similar pre injection PVRs, 28.3 ml +/- 47.2 ml and 37.7 ml +/- 46.4 ml, respectively. The overall total rate of CIC was 14.7%. There were 85 patients without SUI and the CIC rate was 18.8% compared to a CIC rate of 3.3% for the 30 subjects reporting symptoms of SUI (P=0.041).

Conclusions

In this retrospective chart review, subjects with SUI demonstrated a significantly lower rate of incomplete bladder emptying requiring CIC. This may be due to a decrease in outlet resistance associated with SUI. As we gain more experience with the use of ONA in varied clinical settings and patient populations we can look for populations with extremely low rates of CIC.

Funding

None