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J Urol. 2017 May 10. pii: S0022-5347(17)66225-6. doi: 10.1016/j.juro.2017.04.103. [Epub ahead of print]

Characteristics Associated With Treatment Response and Satisfaction in Women Undergoing OnabotulinumtoxinA and Sacral Neuromodulation for Refractory Urgency Urinary Incontinence.

Author information

1
University of Alabama at Birmingham, Birmingham, AL. Electronic address: hrichter@uabmc.edu.
2
Duke University, Durham, NC. Electronic address: cindy.amundsen@duke.edu.
3
RTI International, Research Triangle Park, NC. Electronic address: serickson@rti.org.
4
Cleveland Clinic, Cleveland, OH. Electronic address: jelovsj@ccf.org.
5
University of New Mexico, Albuquerque, NM. Electronic address: ykomesu@salud.unm.edu.
6
University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, PA. Electronic address: chermanskycj2@upmc.edu.
7
University of Pennsylvania, Philadelphia, PA. Electronic address: hharvie@obgyn.upenn.edu.
8
University of California, San Diego, San Diego, CA. Electronic address: malbo@ucsd.edu.
9
Brown University, Providence, RI. Electronic address: dmyers@wihri.org.
10
Oregon Health & Science University, Portland, OR. Electronic address: gregoryt@ohsu.edu.
11
RTI International, Research Triangle Park, NC. Electronic address: dwallace@rti.org.

Abstract

PURPOSE:

To identify clinical and demographic characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation therapies.

MATERIAL AND METHODS:

Data were analyzed from the Refractory Overactive Bladder: Sacral Neuromodulation vs Botulinum Toxin Assessment trial. Baseline participant characteristics and clinical variables associated with two definitions of treatment response: 1) reduction in mean daily urgency incontinence episodes over 6 months 2) ≥50% decrease in urgency incontinence episodes across 6 months were identified. The Overactive Bladder Satisfaction of Treatment questionnaire assessed satisfaction.

RESULTS:

A greater reduction in mean daily urgency incontinence episodes was associated with higher Health Utility Index scores (P<0.001) in the onabotulinuntoxinA group and higher baseline incontinence episodes (P<0.001) in both groups. Increased age was associated with less reduction in incontinence episodes (P<0.001) in both groups. Increasing body mass index (aOR 0.82 per 5 points, 95% CI 0.70, 0.96) was associated with reduced achievement of ≥50% decrease in incontinence episodes after both treatments. Greater age (aOR 0.44 per 10 years, 95% CI 0.30, 0.65) and higher functional comorbidity index (aOR 0.84 per point, 95% CI 0.71, 0.99) were associated with reduced achievement of ≥50% decrease in urgency incontinence episodes in the onabotulinuntoxinA group only (P<0.001; P=0.041, respectively). In the onabotulinumtoxinA group, increased satisfaction was noted with higher Health Utility Index score (p=0.002); less satisfaction with higher age (p=0.001).

CONCLUSION:

Older women with multiple comorbidities and decreased functional and health-related QOL had reduced treatment response and satisfaction with onabotulinumtoxinA compared to sacral neuromodulation for refractory urgency incontinence.

KEYWORDS:

functional comorbidity index; health utility index; onabotulinumtoxinA; refractory urgency urinary incontinence; sacral neuromodulation

PMID:
28501541
DOI:
10.1016/j.juro.2017.04.103
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