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