Presentation Authors: Alexandra Berger*, Cambridge, MA, Valary Raup, Graeme Steele, Elodi Dielubanza, Boston, MA
Introduction: Intradetrusor OnabotulinumtoxinA (BTX-A) is an effective therapy for neurogenic detrusor overactivity (NDO). However, it may be underutilized in non-catheterizing male patients with NDO due to concern for urinary retention, as published rates of retention vary widely and have been established using cohorts which are majority female. We sought to describe the use and outcomes of BTX-A injections in real world cohort of non-catheterizing men with NDO.
Methods: We utilized the Research Patient Data Registry to identify male patients with NDO who underwent BTX-A injections at our institution between 2006-2018. Demographic and clinical data were recorded. Descriptive statistics, chi squared, and Wilcoxon rank sum tests were used for analysis.
Results: We identified 71 non-catheterizing men with NDO who underwent BTX-A, 38 (53.5%) with MS, 28 (39.4%) with PD, and 5 (7.0%) with another neurologic condition. Baseline AUA symptom scores were similar across groups. MS patients were significantly younger than all others. Pre-operative post-void residual urine volume (PVR) was available 63 patients (88.7%) with a median of 55mL (0-406). Patients with MS had higher baseline PVR than those with PD or other neurologic diagnosis (144.5 vs. 37 vs. 0, p=0.0018). The 100 unit dose was utilized in 52% and 200 unit dose in 42%, with no difference in dose distribution across groups. After BTX-A, the median PVR was significantly higher 200mL (p=0.0052). Urinary retention requiring catheterization occurred in 20 (28.2%), with 11 (15.5%) patients requiring long-term catheterization. Repeat BTX-A was performed in 29 patients (40.8%) at a median of 366 (range 70-2785) days after initial treatment. The mean number of BTX-A treatments was 1.99 (1-10). Patients who required catheterization after BTX-A were less likely to have repeat injections (50.0% vs 20.0%, p=0.019). Neither dose nor disease type impacted urinary retention or repeat treatment.
Conclusions: In our series, intradetrusor BTX-A in non-catheterizing men with neurogenic detrusor activity was associated with at least transient urinary retention in < 1/3rd of patients. Urinary retention was a predictor of treatment discontinuation. This therapy deserves further study in male populations.