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GENDER-BASED DIFFERENCES IN THE 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 third-line therapy with botulinum toxin A injection. Botulinum injections have shown success in treating OAB and NB urinary symptoms, but require repeat injections at an interval of 4-12 months. The effect of these factors may be modified by gender, with differential durability when performed in different genders.
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 injection. 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. Patients were stratified by gender, and univariate time-to-event analyses were performed within each group.
RESULTS: Of the available patients, 54 patients met inclusion criteria, of whom 17 were male and 37 were female. Kaplan-Meier estimates of time for 50% of patients to require botulinum reinjection were 328 days for males compared to 385 days for females. On univariate analysis, hypertension (p=0.026), prostate cancer (p<0.001), constipation (p = 0.03), and stress incontinence (p<0.001) were associated with lower durability in males. In females, multiple sclerosis (p = 0.043) and history of UTI (p=0.024) were associated with lower durability.
CONCLUSIONS: Botulinum injection showed a slightly longer durability for female compared to male patients. For males, history of prostate cancer, hypertension, constipation or stress incontinence were associated with lower durability, while for females multiple sclerosis and history of UTI were associated with lower durability. Further study with larger numbers will be needed to confirm and expand on these findings and aid in patient selection and counseling.
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