Urodynamic Predictive Factors for Successful Treatment Outcomes Following Intravesical Botulinum Toxin a Injection in...

Area of Science:

• Urology
• Nephrology
• Pharmacology

Background:

• Overactive bladder (OAB) significantly impacts quality of life.
• Intravesical botulinum toxin A (BoNT-A) is an option for refractory OAB.
• Predictive factors for BoNT-A treatment success require further elucidation.

Purpose of the Study:

• To identify predictive factors for successful intravesical BoNT-A treatment in OAB patients.
• To analyze baseline video urodynamic characteristics associated with treatment outcomes.
• To differentiate predictors based on patient cohorts (male/female, neurogenic/non-neurogenic DO).

Main Methods:

• Retrospective analysis of 571 patients with OAB and detrusor overactivity (DO).
• Patients refractory to OAB medications or intolerant to adverse events were included.
• Outcomes (successful, improved, failed) assessed at 3 months post-injection; video urodynamics compared across subgroups.

Main Results:

• BoNT-A treatment was successful in 55.7%, improved in 27.8%, and failed in 16.5% of patients.
• Predictors for success in men: lower baseline detrusor pressure, higher maximum flow rate (Qmax), larger voided volume, smaller post-void residual (PVR).
• Predictors for success in women: larger voided volume, smaller PVR. Patients with neurogenic DO and detrusor underactivity (DU) generally had unsuccessful outcomes.

Conclusions:

• Baseline video urodynamic parameters can predict intravesical BoNT-A treatment success for refractory OAB.
• Specific urodynamic parameters differ in their predictive value between men and women.
• Neurogenic DO and DU are associated with poor treatment outcomes, guiding patient selection.