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. 2020 May;31(5):871-879.
doi: 10.1007/s00192-019-04007-7. Epub 2019 Jun 20.

Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation

Caroline G Elmer-Lyon  1 , Judy A Streit  2 , Elizabeth B Takacs  3 , Patrick P Ten Eyck  4 , Catherine S Bradley  5
Affiliations

Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation

Caroline G Elmer-Lyon et al. Int Urogynecol J. 2020 May.

Abstract

Introduction and hypothesis: Intradetrusor onabotulinumtoxinA (BTX) and sacral neuromodulation (SNM) are effective treatments for refractory urgency urinary incontinence/overactive bladder (UUI/OAB). BTX carries a risk of urinary tract infection (UTI), which is concerning for the development of multidrug resistant (MDR) UTI. We hypothesized that BTX might carry a higher risk of UTI and MDR UTI compared with SNM and that UTI and MDR UTI risk might increase after repeat BTX injection.

Methods: This retrospective cohort study included women undergoing BTX or SNM for refractory UUI/OAB in 2012-2016. UTI and MDR UTI were assessed up to 1 year post-treatment or until repeat treatment and compared between initial BTX and SNM and between repeat BTX injections. Univariate analyses included Chi-squared and Fisher's exact tests and generalized linear models (GLM) with logit link function. Multivariate analyses used GLM to assess the best predictor variables for any UTI.

Results: One hundred and one patients were included (28 BTX, 73 SNM). Rates of UTI (39.3% [95% CI 21.5, 59.4] BTX vs 37.0% [95% CI 26.0, 49.1] SNM) were similar in the two groups at all time intervals. One MDR UTI occurred after SNM. Risk of UTI did not increase with repeat BTX (11 out of 28 [39.3%], 6 out of 17 [35.3%], and 4 out of 7 [57.1%] after 1, 2, and ≥ 3 treatments respectively; p = 0.62). Multivariate analysis found that history of recurrent UTI (OR 2.5, 95%CI 0.98-6.39) and prolapse repair (OR 4.6, 95%CI 1.23-17.07) had increased odds of UTI.

Conclusions: Rates of UTI were similar in patients undergoing BTX and SNM. MDR UTI was rare. Patients with prior prolapse repair or recurrent UTI may be at a higher risk of UTI after either procedure.

Keywords: Drug resistance; OnabotulinumtoxinA; Sacral neuromodulation; Urgency urinary incontinence; Urinary tract infection.

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Conflict of interest statement

FINANCIAL DISCLAIMER/CONFLICT OF INTEREST: NONE

Figures

Figure 1.
Figure 1.. Eligibility, exclusions, and enrollment.
CIC: clean-intermittent catheterization; SPC: suprapubic catheter; PCN: percutaneous nephrostomy; RT: radiation therapy.
See this image and copyright information in PMC

References

    1. Stewart WF, Van Rooyen JB, Cundiff GW et al. (2003). Prevalence and burden of overactive bladder in the United States. World J Urol 20(6):327–36. doi: 10.1007/s00345-002-0301-4 - DOI - PubMed
    1. Gormley EA, Lightner DJ, Faraday M et al. (2015) Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol 193(5):1572–80. doi: 10.1016/j.juro.2015.01.087 - DOI - PubMed
    1. American Urogynecologic Society and American College of Obstetricians and Gynecologists (2014) Committee opinion: onabotulinumtoxinA and the bladder. Female Pelvic Med Reconstr Surg 20(5):245–7. doi: 10.1097/SPV.0000000000000112 - DOI - PubMed
    1. Weckx F, Tutolo M, De Ridder D, Van der Aa F (2016) The role of botulinum toxin A in treating neurogenic bladder. Transl Androl Urol 5(1):63–71. doi: 10.3978/j.issn.2223-4683.2016.01.10 - DOI - PMC - PubMed
    1. Visco AG, Brubaker L, Richter HE et al. (2012). Anticholinergic therapy vs. onabotulinumtoxina for urgency urinary incontinence. N Engl J Med 367(19):1803–13. doi: 10.1056/NEJMoa1208872 - DOI - PMC - PubMed

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