• Journal Article

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

Citation

Richter, H. E., Amundsen, C. L., Erickson, S. W., Jelovsek, J. E., Komesu, Y., Chermansky, C., ... NICHD Pelvic Floor Disorders Network (2017). Characteristics Associated With Treatment Response and Satisfaction in Women Undergoing OnabotulinumtoxinA and Sacral Neuromodulation for Refractory Urgency Urinary Incontinence. Journal of Urology. DOI: 10.1016/j.juro.2017.04.103

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.