Page 9 - CUA Absracts 2022_Fulldraft

Podium 1: BPH, Trauma/Recon, Neurogenic Bladder, Incontinence/Voiding, Peds

oscopy, and urodynamic testing (± fluoroscopy). Obstruction was identi- POD-1.6. Table 1. Demographics of patient population
fied by urodynamics using the Blaivas criteria or fluoroscopy. Clinical
findings for patients with and without obstruction were compared. Patients No. of patients 29
undergoing sling lysis were assessed for postoperative outcomes. Median age, years (range) 58 (24–76)
Results: A total 106 patients were included with median age of 61 years Gender, n (%) Female 12 (41)
(interquartile range [IQR] 19) and median time since sling surgery of five
years (IQR 8). Fifty-nine percent (63/106) met the definition for bladder Male 17 (59)
outlet obstruction. Patients with obstruction had significantly higher mean Indication for catheterization Incontinence with failed
detrusor pressure (PDet) at maximal flow rate (Qmax) (35 vs. 19 cmH O), CICs (29)
2
lower Qmax (6 vs. 14 mL/s), and higher postvoid residual (PVR) (217 vs. Method of catheterization Suprapubic (16)
72 mL) (p<0.05). A tight suburethral band was the only clinical finding Urethral (13)
significantly associated with obstruction (p=0.003). Time since sling sur-
gery and type of urinary symptoms were not associated with obstruction. Neurogenic bladder, n (%) 28 (97)
Fifty-one (80%) obstructed patients underwent sling lysis, after which 90% Median duration of indwelling catheter 107 (4 weeks–10 years)
reported improvement in voiding symptoms, 41% reported improvement prior to BotA, weeks (range)
in storage symptoms, and 43% reported recurrent incontinence (median
followup 18 months, IQR 20.5). Five patients (5/51, 10%) underwent
redo sling procedure.
Conclusions: Obstruction is common in patients presenting with chronic POD-1.6. Table 2. Indication for BotA treatment
urinary symptoms and a history of sling surgery; however, few clinical
predictors exist and urodynamics may be warranted. Patients undergoing Yes, n (%)
sling lysis should be observed for persistent storage symptoms and recur- Urinary leakage 24 (83)
rent incontinence. Bladder spasms/pain 27 (93)
UTIs 6 (21)
POD-1.6
Urinary symptoms in patients with indwelling catheters receiving
intravesical onabotulinumtoxinA POD-1.6. Table 3. Summary details of BotA treatments
Christopher Bitcon , Ashley R. Cox 1 No. of BotA treatments, mean (range) 3 (1–8)
1
1 Department of Urology, Dalhousie University, Halifax, NS, Canada
Introduction: Patients with long-term indwelling catheters may suffer from No. of patients with ongoing BotA 17
bothersome urinary symptoms, including bladder spasms, urine leakage, Time interval of injections (%) 4 (14)
and urinary tract infections (UTIs) leading to a reduced quality of life. 1-3 3–4 months 7 (24)
The use of onabotulinumtoxinA (BotA) has been poorly studied as a 6 months 12 (41)
treatment option for this patient population. This study aimed to assess 6–12 months 5 (17)
the role of intravesical BotA injections on bothersome urinary symptoms
in patients with indwelling catheters. 12 months
Methods: We performed a single-institution, retrospective chart review BotA dose in positive responders (units) 200 U
of patients who underwent intravesical BotA injections with indwelling Complications 0
catheters from January 2010 to May 2020. Patients with urethral or supra-
pubic catheters placed for 12 weeks or greater were included. Patient
demographics, diagnosis, indications for indwelling catheter, method of were concurrently on an anticholinergic and a beta-3 agonist medication,
catheterization, and control of urinary symptoms were recorded. respectively. Twenty-seven patients reported significant bladder spasms
Results: A total of 29 catheterized patients were treated with intravesical and 24 reported concerns with urinary incontinence prior to undergoing
BotA injections (Table 1); 28 had a diagnosis of neurogenic lower urin- BotA (Table 2). Twenty-two (81%) patients reported a decrease in blad-
ary tract dysfunction. Sixteen patients had suprapubic catheters, while der spasms and 17 (71%) reported a decrease in the amount of leakage
13 had urethral catheters. Approximately 50% and 25% of the patients per urethra after BotA injections (Figure 1). The average number of BotA
treatments was three per patient (range 1–8 treatments) (Table 3). All
patients that reported benefit in urinary symptoms were treated with 200
units of BotA.
30 Conclusions: Our results suggest that BotA may be beneficial for treating
bothersome urinary symptoms, mainly incontinence and bladder spasms,
25 in patients with indwelling catheters. BotA appears to be safe and well-
tolerated in this patient population.
References
No. of patients 15 1. Mackay WG, MacIntosh T, Kydd A, et al. Living with an indwelling
20
urethral catheter in a community setting: Exploring triggers for
unscheduled community nurse “out-of-hours” visits. J Clin Nurs
2018;27:866-75. https://doi.org/10.1111/jocn.14117
2. Lekka E, Lee LK. Successful treatment with intradetrusor botu-
10
linum-a toxin for urethral urinary leakage (catheter bypassing)
in patients with end-staged multiple sclerosis and indwelling
5 suprapubic catheters. Euro Urol 2006;50:806-10. https://doi.
org/10.1016/j.eururo.2005.12.015
3. Young MJ, Osman NI, Phillips L, et al. Another therapeutic role for
0
Spasms Leakage UTIs intravesical botulinum toxin: Patients with long-stay catheters and
refractory bladder pain and catheter bypass leakage. Euro Urol
POD-1.6. Figure 1. Number of patients with complaints of spasms, leakage, Focus 2020;6:339-43. https://doi.org/10.1016/j.euf.2018.10.011
and UTIs pre- and post-BotA injections (black and light grey, respectively).

CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S7