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FACTORS ASSOCIATED WITH DURABILITY OF INTRAVESICAL BOTULINUM TOXIN A INJECTION
Jay Vance, MS1, Kristian Stensland, MD2, Bennett Sluis, BS1, Arthur Mourtzinos, MD MBA2, Lara MacLachlan, MD2.
1Tufts University School of Medicine, Boston, MA, USA, 2Lahey Hospital & Medical Center, Burlington, MA, USA.
BACKGROUND: Patients suffering from overactive bladder (OAB) and neurogenic bladder (NB) without response to behavioral and pharmaceutical intervention may opt for botulinum toxin A injection or sacral nerve stimulation (SNS). Botulinum injections have shown success in treating OAB and NB urinary symptoms, but require repeat injections at an interval of 4-12 months. This study seeks to identify factors associated with the durability of this therapeutic effect.
METHODS: Patients undergoing treatment for OAB and NB at Lahey Hospital and Medical Center between 2004 and 2016 were identified. Demographic, clinical and treatment data were extracted from patient charts. Patients were included if they had at least 1 botulinum injections. Time from initial to second botulinum injection was defined as therapeutic durability; time from initial injection to last clinic follow-up was defined and time to event analyses were employed: univariate analysis via log-rank method and multivariate Cox proportional hazards were used to identify associations with therapeutic durability. The multivariate Cox model comprised univariate factors with p values below 0.1 and a priori clinical variables. Significance was defined at the α= 0.05 level.
RESULTS: Of the available patients, 54 patients met inclusion criteria. Median time to repeat injection for those who had a second injection was 259 days. Kaplan-Meier survival estimated that 50% of patients required reinjection at 330 days. On univariate analysis, history of spinal cord injury (p = 0.041), prostate cancer (p < 0.001), history of stroke/CVA (p=0.037), and history of UTI (p=0.013) were significantly associated with lower therapeutic durability. On multivariate analysis, only prostate cancer (OR 50.2, 95% CI 2.95-854, p = 0.0068) and history of UTI (OR 4.11, 95% CI 1.10-15.3, p = 0.035) were associated with lower therapeutic durability.
CONCLUSIONS: Botulinum injection showed a median durability of roughly 9 months. Patients with prostate cancer or a history of UTI had a statistically significantly higher risk of lower durability of botulinum injection. Further study is warranted to identify further etiologic origins of these connections or elucidate other associated cofactors.
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