Videourodynamic factors predictive of successful onabotulinumtoxinA urethral sphincter injection for neurogenic or non-neurogenic detrusor underactivity

Abstract

Objective: The aim of the present study was to analyze treatment outcomes and identify videourodynamic factors predictive of successful urethral onabotulinumtoxinA treatment of neurogenic and non-neurogenic detrusor underactivity (DU). Methods: Patients with DU refractory to medical treatment were treated with injections totaling 100 U onabotulinumtoxinA into the urethral sphincter. Treatment outcomes were assessed 1 month after treatment using the Global Response Assessment. The videourodynamic parameters evaluated included bladder neck status during voiding, bladder sensation, detrusor pressure, maximum flow rate, and post-void residual volume. Treatment outcome was analyzed by patient and baseline videourodynamic characteristics. Results: In all, 60 patients (27 with non-neurogenic and 33 with neurogenic DU) were included in the study and received urethral sphincter injections of 100 U onabotulinumtoxinA in total. Good outcomes were reported in 36 (60%) patients (20 [74.1%] with non-neurogenic and 16 [48.5%] with neurogenic DU). Treatment outcome was significantly better in patients with non-neurogenic than neurogenic DU (P =.039). However, good treatment outcome was not related to age, gender, or any videourodynamic variables, except for an open bladder neck during voiding vs non-opening bladder neck (94.3% vs. 12.0%; P