- Email: [email protected]
MP77-14 SACRAL NEUROMODULATION FOR REFRACTORY OVERACTIVE BLADDER AFTER PRIOR INTRAVESICAL ONABOTULINUMTOXINA TREATMENT.
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
METHODS: Data from the 2012 National Health and Nutrition Examination Survey (NHANES) cycle was analyzed for all individuals who participated in the biospecimen program. Urinary concentrations of 13 heavy metals, 3 perchlorates, 2 pesticides, 14 phthalates, 10 polyaromatic hydrocarbons (PAH), 12 polyfluoroalkyl (PFC) chemicals, and 26 volatile organic compounds (VOCs) were identified and measured. Urinary concentration of each pollutant was normalized to urine creatinine and log-transformed. Lower urinary tract symptoms were defined as self-reported stress incontinence, urge incontinence and nocturia. Each pollutant was examined in a weighted, variance-corrected multivariate logistic regression for association with each outcome of interest. Models examining male subjects were adjusted for age, body mass index, race, diabetes, and self-reported health status. Models examining female subjects were also adjusted for parity. RESULTS: 602 women and 565 men were included in the study. Urinary levels of pollutants were consistently higher in men. Prevalence of incontinence and nocturia was significantly higher among women. Among women, no association was noted between pollutant levels and the outcomes of interest. Among men, increased concentrations of 3 VOCs, 2 heavy metals and 1 perchlorate were associated with increased stress incontinence; increased concentrations of 2 VOCs, 1 heavy metal and 3 PAHs were associated with increased urge incontinence; and increased levels of 8 VOCs, 2 heavy metals, 6 PAHs, 1 pesticide, and 1 perchlorate were associated with increased nocturia. CONCLUSIONS: This study demonstrates that increased urinary levels of certain environmental and industrial pollutants are associated with increased lower urinary tract (LUT) dysfunction in men. Exposure to these pollutants has been associated with neurotoxicity and other adverse health outcomes. We hypothesize that pollutant exposure may be a marker for neurological injury leading to LUT dysfunction. The distinct etiology of incontinence between genders likely accounts for lack of association between pollutants and LUT dysfunction in women. Source of Funding: None
MP77-14 SACRAL NEUROMODULATION FOR REFRACTORY OVERACTIVE BLADDER AFTER PRIOR INTRAVESICAL ONABOTULINUMTOXINA TREATMENT. Nathan Hoag*, Melbourne, Australia; Sophie Plagakis, Samantha Pillay, Ailsa Wilson Edwards, Adelaide, Australia; Johan Gani, Melbourne, Australia INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is a well-established treatment modality for refractory overactive bladder (OAB). There is a paucity of evidence examining the use of SNM in patients who have received prior intravesical onabotulinumtoxinA (BTXA) treatment. We aim to review those patients who underwent SNM for refractory OAB following treatment with BTXA. METHODS: A retrospective chart review was conducted to identify patients who had undergone prior intravesical BTXA for refractory OAB, then subsequent first-stage SNM. Patient demographics, number/dosage of BTXA, and Patient Global Improvement Index (PGI-I) were recorded. Successful first-stage SNM was defined as subjective patient improvement of greater than 50%. RESULTS: 83 patients were identified having undergone SNM for OAB, of which 36 had prior BTXA treatment and were included in the series. Average age was 60.9 years (range 22-86) and 35/36 (97.2%) were female. 25/36 (69.4%) had discontinued BTXA due to ineffectiveness, 9/36 (25.0%) retention, or fear of, and 2/36 (5.5%) adverse reaction. 23/36 (63.9%) of patients had successful first-stage SNM, and underwent insertion of implantable pulse generator, compared to 33/47 (70.2%) in those who had never been treated with BTXA (p ¼ 0.5). In the subset of patients for whom BTXA had proven ineffective, 16/25 (64.0%) had a successful first stage test. Mean PGI-I score was 2.6 (range 1-4). With a mean follow up of 25.8 months (range 3-53), 17/23 (73.9%) were satisfied, and using the device at last follow-up.
e1021
CONCLUSIONS: SNM is an acceptable treatment option in those patients who have had prior BTXA treatment for refractory OAB, even in those for whom BTXA proved ineffective. Success rates were within the published range, and comparable to our own results, for SNM in OAB patients without prior BTXA treatment. Source of Funding: None
MP77-15 QUALITY OF LIFE AFTER SACRAL NEUROMODULATION: DOES IT DIFFER IN SUBJECTS ACROSS DIFFERENT OVERACTIVE BLADDER DIAGNOSES? Karen Noblett*, Riverside, CA; Jeffrey Mangel, Cleveland, OH; Craig Comiter, Stanford, CA; Erin Bird, Temple, TX; Tomas L. Griebling, Kansas City, KS; Suzette E. Sutherland, Seattle, WA; Kira Q. Stolen, Fangyu Kan, Minneapolis, MN; Steven Siegel, Woodbury, MN INTRODUCTION AND OBJECTIVES: These retrospective analyses aim to characterize the effect of sacral neuromodulation (SNM), delivered by the InterStimâ system, on patient reported quality of life (QOL) in subjects with urinary urge incontinence (UI), urge frequency (UF), or both 3 years after therapy initiation. Subjects with UI or UF, who had not exhausted all medication options (failed at least 1 anticholinergic medication and had at least 1 medication not tried) were included in the InSite study. METHODS: Subjects were categorized into 3 groups of OAB symptoms: UI only, UF only, or both. QOL from baseline through 36 months was evaluated using the validated disease-specific International Consultation on Incontinence Modular Questionnaire (ICIQ-OABqol). QOL was analyzed as change from baseline in the 3 subject groups and pairwise comparisons were made between subgroups at 36 months. RESULTS: Of 272 subjects that were implanted, 91% were female and the mean age was 57 years. Of the implanted subjects qualified as UI or UF with paired QOL data at baseline and 36 months, 104 subjects (51%) had both UI and UF symptoms while 54 (27%) had UI only and 44 (22%) had UF only. All 3 groups demonstrated significant improvement from baseline to 36 months in Health Related QOL (Figure) and the following subscales of ICIQ-OABqol: Concern, Coping, Sleep, Social, and Interference (all p<0.0001). No statistical difference between the 3 groups was observed in Health Related QOL at 36 months. When assessing subscale results, subjects with UF only and both UI and UF reported greater improvements in the sleep subscale compared to UI only subjects (both p<0.02). Additionally, subjects with both UI and UF, reported greater improvement in the coping subscale compared to UI only (p<0.05). Results from the urinary symptom Interference measure show that all 3 groups reported improved or greatly improved condition at 36 months (80%, 83%, 80% for UI, UF or both, respectively). CONCLUSIONS: These retrospective analyses indicate that SNM results in consistent improvement in overall Health Related QOL at 36 months follow-up in subjects with UI, UF or both. Additionally, understanding the sub-scale results warrants further study.
Source of Funding: The InSite trial was supported by Medtronic.
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
METHODS: Data from the 2012 National Health and Nutrition Examination Survey (NHANES) cycle was analyzed for all individuals who participated in the biospecimen program. Urinary concentrations of 13 heavy metals, 3 perchlorates, 2 pesticides, 14 phthalates, 10 polyaromatic hydrocarbons (PAH), 12 polyfluoroalkyl (PFC) chemicals, and 26 volatile organic compounds (VOCs) were identified and measured. Urinary concentration of each pollutant was normalized to urine creatinine and log-transformed. Lower urinary tract symptoms were defined as self-reported stress incontinence, urge incontinence and nocturia. Each pollutant was examined in a weighted, variance-corrected multivariate logistic regression for association with each outcome of interest. Models examining male subjects were adjusted for age, body mass index, race, diabetes, and self-reported health status. Models examining female subjects were also adjusted for parity. RESULTS: 602 women and 565 men were included in the study. Urinary levels of pollutants were consistently higher in men. Prevalence of incontinence and nocturia was significantly higher among women. Among women, no association was noted between pollutant levels and the outcomes of interest. Among men, increased concentrations of 3 VOCs, 2 heavy metals and 1 perchlorate were associated with increased stress incontinence; increased concentrations of 2 VOCs, 1 heavy metal and 3 PAHs were associated with increased urge incontinence; and increased levels of 8 VOCs, 2 heavy metals, 6 PAHs, 1 pesticide, and 1 perchlorate were associated with increased nocturia. CONCLUSIONS: This study demonstrates that increased urinary levels of certain environmental and industrial pollutants are associated with increased lower urinary tract (LUT) dysfunction in men. Exposure to these pollutants has been associated with neurotoxicity and other adverse health outcomes. We hypothesize that pollutant exposure may be a marker for neurological injury leading to LUT dysfunction. The distinct etiology of incontinence between genders likely accounts for lack of association between pollutants and LUT dysfunction in women. Source of Funding: None
MP77-14 SACRAL NEUROMODULATION FOR REFRACTORY OVERACTIVE BLADDER AFTER PRIOR INTRAVESICAL ONABOTULINUMTOXINA TREATMENT. Nathan Hoag*, Melbourne, Australia; Sophie Plagakis, Samantha Pillay, Ailsa Wilson Edwards, Adelaide, Australia; Johan Gani, Melbourne, Australia INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is a well-established treatment modality for refractory overactive bladder (OAB). There is a paucity of evidence examining the use of SNM in patients who have received prior intravesical onabotulinumtoxinA (BTXA) treatment. We aim to review those patients who underwent SNM for refractory OAB following treatment with BTXA. METHODS: A retrospective chart review was conducted to identify patients who had undergone prior intravesical BTXA for refractory OAB, then subsequent first-stage SNM. Patient demographics, number/dosage of BTXA, and Patient Global Improvement Index (PGI-I) were recorded. Successful first-stage SNM was defined as subjective patient improvement of greater than 50%. RESULTS: 83 patients were identified having undergone SNM for OAB, of which 36 had prior BTXA treatment and were included in the series. Average age was 60.9 years (range 22-86) and 35/36 (97.2%) were female. 25/36 (69.4%) had discontinued BTXA due to ineffectiveness, 9/36 (25.0%) retention, or fear of, and 2/36 (5.5%) adverse reaction. 23/36 (63.9%) of patients had successful first-stage SNM, and underwent insertion of implantable pulse generator, compared to 33/47 (70.2%) in those who had never been treated with BTXA (p ¼ 0.5). In the subset of patients for whom BTXA had proven ineffective, 16/25 (64.0%) had a successful first stage test. Mean PGI-I score was 2.6 (range 1-4). With a mean follow up of 25.8 months (range 3-53), 17/23 (73.9%) were satisfied, and using the device at last follow-up.
e1021
CONCLUSIONS: SNM is an acceptable treatment option in those patients who have had prior BTXA treatment for refractory OAB, even in those for whom BTXA proved ineffective. Success rates were within the published range, and comparable to our own results, for SNM in OAB patients without prior BTXA treatment. Source of Funding: None
MP77-15 QUALITY OF LIFE AFTER SACRAL NEUROMODULATION: DOES IT DIFFER IN SUBJECTS ACROSS DIFFERENT OVERACTIVE BLADDER DIAGNOSES? Karen Noblett*, Riverside, CA; Jeffrey Mangel, Cleveland, OH; Craig Comiter, Stanford, CA; Erin Bird, Temple, TX; Tomas L. Griebling, Kansas City, KS; Suzette E. Sutherland, Seattle, WA; Kira Q. Stolen, Fangyu Kan, Minneapolis, MN; Steven Siegel, Woodbury, MN INTRODUCTION AND OBJECTIVES: These retrospective analyses aim to characterize the effect of sacral neuromodulation (SNM), delivered by the InterStimâ system, on patient reported quality of life (QOL) in subjects with urinary urge incontinence (UI), urge frequency (UF), or both 3 years after therapy initiation. Subjects with UI or UF, who had not exhausted all medication options (failed at least 1 anticholinergic medication and had at least 1 medication not tried) were included in the InSite study. METHODS: Subjects were categorized into 3 groups of OAB symptoms: UI only, UF only, or both. QOL from baseline through 36 months was evaluated using the validated disease-specific International Consultation on Incontinence Modular Questionnaire (ICIQ-OABqol). QOL was analyzed as change from baseline in the 3 subject groups and pairwise comparisons were made between subgroups at 36 months. RESULTS: Of 272 subjects that were implanted, 91% were female and the mean age was 57 years. Of the implanted subjects qualified as UI or UF with paired QOL data at baseline and 36 months, 104 subjects (51%) had both UI and UF symptoms while 54 (27%) had UI only and 44 (22%) had UF only. All 3 groups demonstrated significant improvement from baseline to 36 months in Health Related QOL (Figure) and the following subscales of ICIQ-OABqol: Concern, Coping, Sleep, Social, and Interference (all p<0.0001). No statistical difference between the 3 groups was observed in Health Related QOL at 36 months. When assessing subscale results, subjects with UF only and both UI and UF reported greater improvements in the sleep subscale compared to UI only subjects (both p<0.02). Additionally, subjects with both UI and UF, reported greater improvement in the coping subscale compared to UI only (p<0.05). Results from the urinary symptom Interference measure show that all 3 groups reported improved or greatly improved condition at 36 months (80%, 83%, 80% for UI, UF or both, respectively). CONCLUSIONS: These retrospective analyses indicate that SNM results in consistent improvement in overall Health Related QOL at 36 months follow-up in subjects with UI, UF or both. Additionally, understanding the sub-scale results warrants further study.
Source of Funding: The InSite trial was supported by Medtronic.