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MP17-11 INTRADETRUSOR INJECTIONS OF BOTULINUM TOXIN A IN ADULT PATIENTS WITH SPINA BIFIDA: A MULTICENTER STUDY
THE JOURNAL OF UROLOGYâ
e188
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
MP17-11 INTRADETRUSOR INJECTIONS OF BOTULINUM TOXIN A IN ADULT PATIENTS WITH SPINA BIFIDA: A MULTICENTER STUDY benoit peyronnet*, rennes, France; juliette hascoet, Rennes, France; , evelyne castel-lacanal, Toulouse, France; mathieu roumiguie mireille damphousse, nelly senal, Rennes, France; philippe marque, , Toulouse, France; andrea manunta, Rennes, France; xavier game Toulouse, France
Source of Funding: Rose Khavari is a scholar supported in part by NIH grant K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program to Dolores J Lamb (DJL) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health.
MP17-10 SACRAL NEUROMODULATION THERAPY IN PATIENTS WITH NEUROLOGIC LOWER URINARY TRACT DYSFUNCTION e SHOULD IT REMAIN AN OFF LABEL INDICATION? ANALYSIS OF 80 CONSECUTIVE CASES Henry Okafor*, Bradley Gill, Javier Pizarro-Berdichevsky, Marisa Clifton, Elodi Dielubanza, Anna Faris, Adrienne Quirouet, Howad Goldman, Raymond Rackley, Sandip Vasavada, Courtenay Moore, Cleveland, OH INTRODUCTION AND OBJECTIVES: Although early Sacral Neuromodulation (SNM) trials excluded patients with neurologic lower urinary tract dysfunction (NLUTD), an increasing number of small studies show outcomes in these patients are similar to those without NLUTD. The use of SNM in NLUTD remains off label. The aim of this study was to compare SNM in patients with NLUTD to those without NLUTD and determine clinical factors associated with successful utilization of SNM. METHODS: A retrospective review of patients who underwent SNM between 2011 and 2015 was completed. Patients with a neurologic diagnosis in the electronic chart were identified and placed in the NLUTD cohort. Demographic and clinical characteristics of the NLUTD and non-NLUTD cohort were identified. Rates of progression to stage 2, revision and explant were analyzed. The data were examined using Pearson’s chi-square and Fisher exact tests as appropriate. RESULTS: Out of 412 patients, 80 (19.4%) had NLUTD at time of SNM with a mean age was 54 17 years. 75% of the NLUTD group was female (N¼60). The neurogenic diagnoses were: spinal cord injury 28.8% (N¼23), multiple sclerosis 23.8% (N¼19), Stroke 15% (N¼12), cerebral palsy12.5% (N¼10), peripheral nervous system disorders 12.5% (N¼10) and Parkinson’s disease 7.5% (N¼6). The primary indication for SNM was urgency incontinence in 62.5% of the NLUTD group (N¼50) and 59.5% in the non-NLUTD group (N¼197). Progression to stage 2 SNM was similar in both groups, 90% in NLUTD versus 87% in non-NLUTD. Revision rates were higher in the NLUTD cohort compared to non-NLTUD, 46% versus 35%, but this trend did not reach statistical significance (p¼0.09). There was a statistically significant higher explant rate in the NLUTD group, 33% vs 20% (p¼0.0194) and the most common reason for explant in both groups was loss of efficacy. Progression to stage 2, revision rates, and explant rates for each type of neurologic diagnosis did not have any statistically significant difference. CONCLUSIONS: The primary indication for SNM in both NLUTD and non-NLUTD was urgency incontinence. The specific neurologic diagnosis is not predictive of SNM success, revision, or explants rates. However, patients with NLUTD appear more likely to need the device explanted when compared to patients with nonNLUTD. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Botulinum toxin injections have become the gold standard treatment of neurogenic detrusor overactivity (NDO) refractory to anticholinergic therapy. Spina bifida is a common cause of neurogenic bladder but patients with spinal dysraphism were not included in the large randomized trials that have evaluated the safety and efficacy of intradetrusor injections of botulinum toxin in NDO. Only a few studies have aimed to assess the outcomes of botulinum toxin injections in spina bifida patients and all of them were conducted in children. The aim of the present study was to evaluate the outcomes of intradetrusor botulinum toxin injections in adult patients with spina bifida and to compare them to those observed in patients with spinal cord injury (SCI). METHODS: All adult patients with spina bifida treated with intradetrusor injections of botulinum toxin between 2007 and 2014 in two centers were included retrospectively. All SCI patients treated with intradetrusor injections of botulinum toxin during the same period were also included as a control group. All patients had a voiding diary and urodynamics before and 6 weeks after injection. The success of toxin injection was defined as resolution of urgency, urinary incontinence and detrusor overactivity. RESULTS: Twenty-five spina bifida patients and 81 patients with SCI were included for analysis. There were more women in spina group (57.7% vs. 18.3%; p <0.0001) and patients were younger than in the spinal cord injured group (27.9 years vs. 38.9 years; p ¼ 0.0002). The success rates (52% vs. 63%, p ¼ 0.34) and resolution of urinary incontinence (68% vs. 71%; p ¼ 0.44) were comparable between the 2 groups. There was no significant difference in the decrease in the maximum bladder pressure (-7.7 cm H2O vs. -17.1 cm H2O, p ¼ 0.33). Ten spina bifida patients and 16 SCI patients had a low compliance bladder (compliance <20 ml / cm H2O; 40% vs. 19%, p ¼ 0.04). In this subgroup of low compliance bladder success rate was lower in spina bifida patients (20% vs. 69%, p ¼ 0.02). CONCLUSIONS: When considering all patients, the efficacy of botulinum toxin in adult patients with spina bifida is comparable to the one observed in spinal cord injuries. However the efficacy of botulinum toxin is much lower for spina bifida patients with low compliance bladder in comparison to low compliance bladder of patients with SCI. Source of Funding: none
MP17-12 SERIAL BOTULINUM TOXIN INJECTIONS OFFER DURABLE RESULTS FOR NEUROGENIC BLADDER: 4 YEAR URODYNAMIC OUTCOMES Alexandra Rehfuss*, Gabriel Leinwand, Paul Feustel, Elise De, Albany, NY INTRODUCTION AND OBJECTIVES: Botulinum toxin type A (BTxA) has been shown to be effective for management of neurogenic detrusor overactivity in series reporting short term urodynamic data. Few studies report on long term results. We report on urodynamic (UDS) outcomes at mean 44 months after initiating serial BTxA injections. METHODS: Single center retrospective analysis of UDS prior to and following serial BTxA injections performed for management of neurogenic detrusor overactivity, poor compliance or low capacity. Primary outcome was urodynamic maximum cystometric capacity. Secondary outcomes included urodynamic detrusor overactivity, leak, maximum detrusor pressure, compliance, and post void residual
e188
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
MP17-11 INTRADETRUSOR INJECTIONS OF BOTULINUM TOXIN A IN ADULT PATIENTS WITH SPINA BIFIDA: A MULTICENTER STUDY benoit peyronnet*, rennes, France; juliette hascoet, Rennes, France; , evelyne castel-lacanal, Toulouse, France; mathieu roumiguie mireille damphousse, nelly senal, Rennes, France; philippe marque, , Toulouse, France; andrea manunta, Rennes, France; xavier game Toulouse, France
Source of Funding: Rose Khavari is a scholar supported in part by NIH grant K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program to Dolores J Lamb (DJL) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health.
MP17-10 SACRAL NEUROMODULATION THERAPY IN PATIENTS WITH NEUROLOGIC LOWER URINARY TRACT DYSFUNCTION e SHOULD IT REMAIN AN OFF LABEL INDICATION? ANALYSIS OF 80 CONSECUTIVE CASES Henry Okafor*, Bradley Gill, Javier Pizarro-Berdichevsky, Marisa Clifton, Elodi Dielubanza, Anna Faris, Adrienne Quirouet, Howad Goldman, Raymond Rackley, Sandip Vasavada, Courtenay Moore, Cleveland, OH INTRODUCTION AND OBJECTIVES: Although early Sacral Neuromodulation (SNM) trials excluded patients with neurologic lower urinary tract dysfunction (NLUTD), an increasing number of small studies show outcomes in these patients are similar to those without NLUTD. The use of SNM in NLUTD remains off label. The aim of this study was to compare SNM in patients with NLUTD to those without NLUTD and determine clinical factors associated with successful utilization of SNM. METHODS: A retrospective review of patients who underwent SNM between 2011 and 2015 was completed. Patients with a neurologic diagnosis in the electronic chart were identified and placed in the NLUTD cohort. Demographic and clinical characteristics of the NLUTD and non-NLUTD cohort were identified. Rates of progression to stage 2, revision and explant were analyzed. The data were examined using Pearson’s chi-square and Fisher exact tests as appropriate. RESULTS: Out of 412 patients, 80 (19.4%) had NLUTD at time of SNM with a mean age was 54 17 years. 75% of the NLUTD group was female (N¼60). The neurogenic diagnoses were: spinal cord injury 28.8% (N¼23), multiple sclerosis 23.8% (N¼19), Stroke 15% (N¼12), cerebral palsy12.5% (N¼10), peripheral nervous system disorders 12.5% (N¼10) and Parkinson’s disease 7.5% (N¼6). The primary indication for SNM was urgency incontinence in 62.5% of the NLUTD group (N¼50) and 59.5% in the non-NLUTD group (N¼197). Progression to stage 2 SNM was similar in both groups, 90% in NLUTD versus 87% in non-NLUTD. Revision rates were higher in the NLUTD cohort compared to non-NLTUD, 46% versus 35%, but this trend did not reach statistical significance (p¼0.09). There was a statistically significant higher explant rate in the NLUTD group, 33% vs 20% (p¼0.0194) and the most common reason for explant in both groups was loss of efficacy. Progression to stage 2, revision rates, and explant rates for each type of neurologic diagnosis did not have any statistically significant difference. CONCLUSIONS: The primary indication for SNM in both NLUTD and non-NLUTD was urgency incontinence. The specific neurologic diagnosis is not predictive of SNM success, revision, or explants rates. However, patients with NLUTD appear more likely to need the device explanted when compared to patients with nonNLUTD. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Botulinum toxin injections have become the gold standard treatment of neurogenic detrusor overactivity (NDO) refractory to anticholinergic therapy. Spina bifida is a common cause of neurogenic bladder but patients with spinal dysraphism were not included in the large randomized trials that have evaluated the safety and efficacy of intradetrusor injections of botulinum toxin in NDO. Only a few studies have aimed to assess the outcomes of botulinum toxin injections in spina bifida patients and all of them were conducted in children. The aim of the present study was to evaluate the outcomes of intradetrusor botulinum toxin injections in adult patients with spina bifida and to compare them to those observed in patients with spinal cord injury (SCI). METHODS: All adult patients with spina bifida treated with intradetrusor injections of botulinum toxin between 2007 and 2014 in two centers were included retrospectively. All SCI patients treated with intradetrusor injections of botulinum toxin during the same period were also included as a control group. All patients had a voiding diary and urodynamics before and 6 weeks after injection. The success of toxin injection was defined as resolution of urgency, urinary incontinence and detrusor overactivity. RESULTS: Twenty-five spina bifida patients and 81 patients with SCI were included for analysis. There were more women in spina group (57.7% vs. 18.3%; p <0.0001) and patients were younger than in the spinal cord injured group (27.9 years vs. 38.9 years; p ¼ 0.0002). The success rates (52% vs. 63%, p ¼ 0.34) and resolution of urinary incontinence (68% vs. 71%; p ¼ 0.44) were comparable between the 2 groups. There was no significant difference in the decrease in the maximum bladder pressure (-7.7 cm H2O vs. -17.1 cm H2O, p ¼ 0.33). Ten spina bifida patients and 16 SCI patients had a low compliance bladder (compliance <20 ml / cm H2O; 40% vs. 19%, p ¼ 0.04). In this subgroup of low compliance bladder success rate was lower in spina bifida patients (20% vs. 69%, p ¼ 0.02). CONCLUSIONS: When considering all patients, the efficacy of botulinum toxin in adult patients with spina bifida is comparable to the one observed in spinal cord injuries. However the efficacy of botulinum toxin is much lower for spina bifida patients with low compliance bladder in comparison to low compliance bladder of patients with SCI. Source of Funding: none
MP17-12 SERIAL BOTULINUM TOXIN INJECTIONS OFFER DURABLE RESULTS FOR NEUROGENIC BLADDER: 4 YEAR URODYNAMIC OUTCOMES Alexandra Rehfuss*, Gabriel Leinwand, Paul Feustel, Elise De, Albany, NY INTRODUCTION AND OBJECTIVES: Botulinum toxin type A (BTxA) has been shown to be effective for management of neurogenic detrusor overactivity in series reporting short term urodynamic data. Few studies report on long term results. We report on urodynamic (UDS) outcomes at mean 44 months after initiating serial BTxA injections. METHODS: Single center retrospective analysis of UDS prior to and following serial BTxA injections performed for management of neurogenic detrusor overactivity, poor compliance or low capacity. Primary outcome was urodynamic maximum cystometric capacity. Secondary outcomes included urodynamic detrusor overactivity, leak, maximum detrusor pressure, compliance, and post void residual