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. 2022 Jan;41(1):432-447.
doi: 10.1002/nau.24845. Epub 2021 Dec 2.

Predicting outcomes after intradetrusor onabotulinumtoxina for non-neurogenic urgency incontinence in women

Whitney K Hendrickson  1 , Gongbo Xie  2 , David D Rahn  3 , Cindy L Amundsen  1 , James A Hokanson  4 , Megan Bradley  5 , Ariana L Smith  6 , Vivian W Sung  7 , Anthony G Visco  1 , Sheng Luo  2 , J Eric Jelovsek  1
Affiliations

Predicting outcomes after intradetrusor onabotulinumtoxina for non-neurogenic urgency incontinence in women

Whitney K Hendrickson et al. Neurourol Urodyn. 2022 Jan.

Abstract

Aims: Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI).

Methods: Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months. Model discrimination of Cox and logistic regression models was calculated using c-index. Mean absolute error determined accuracy of the linear model. Calibration was demonstrated using calibration curves. All models were internally validated using bootstrapping.

Results: Median time to recurrence was 6 (interquartile range [IQR]: 2-12) months. Increasing age, 200 units of onabotulinumtoxinA, higher body mass index (BMI) and baseline UUIE were associated with decreased time to recurrence. The c-index was 0.63 (95% confidence interval [CI]: 0.59, 0.67). Median change in daily UUIE from baseline at 6 months was -3.5 (IQR: -5.0, -2.3). Increasing age, lower baseline UUIE, 200 units of onabotulinumtoxinA, higher BMI and IIQ-SF were associated with less improvement in UUIE. The mean absolute error predicting change in UUIE was accurate to 1.6 (95% CI: 1.5, 1.7) UUI episodes. The overall rate of self-catheterization was 17.6% (95% CI: 13.6%-22.4%). Lower BMI, 200 units of onabotulinumtoxinA, increased baseline postvoid residual and maximum capacity were associated with higher risk of self-catheterization. The c-index was 0.66 (95% CI: 0.61, 0.76). The three calculators are available at http://riskcalc.duke.edu.

Conclusions: After external validation, these models will assist clinicians in providing more accurate estimates of expected treatment outcomes after onabotulinumtoxinA for non-neurogenic UUI in women.

Keywords: ABC; BoNT-A; ROSETTA; UUI; botox; prediction model; urgency urinary incontinence.

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Conflict of interest statement

Conflict of Interest: C.L.A reports funding from BlueWind. M.B. reports research support from Hologics and Axonics. D.D.R. reports research support from Pfizer. All other authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:. Calibration Plots for Models
A. Calibration plot for the time to recurrence model over 12 months. B. Calibration plot for the change in urgency urinary incontinence episode model at 6 months. C. Calibration plot for the self-catheterization model over 6 months. Abbreviations: UUIE, Urgency urinary incontinence episodes. Calibration curves fitted using the rms package, where apparent and bias-corrected curves are smoothed using loess. The bias-corrected curves are adjusted for optimism using bootstrapping with 1000 repetitions in order to correct for overfitting. Rug plots along the top X-axis show the relative prevalence of events at each probability.
Figure 1:
Figure 1:. Calibration Plots for Models
A. Calibration plot for the time to recurrence model over 12 months. B. Calibration plot for the change in urgency urinary incontinence episode model at 6 months. C. Calibration plot for the self-catheterization model over 6 months. Abbreviations: UUIE, Urgency urinary incontinence episodes. Calibration curves fitted using the rms package, where apparent and bias-corrected curves are smoothed using loess. The bias-corrected curves are adjusted for optimism using bootstrapping with 1000 repetitions in order to correct for overfitting. Rug plots along the top X-axis show the relative prevalence of events at each probability.
Figure 1:
Figure 1:. Calibration Plots for Models
A. Calibration plot for the time to recurrence model over 12 months. B. Calibration plot for the change in urgency urinary incontinence episode model at 6 months. C. Calibration plot for the self-catheterization model over 6 months. Abbreviations: UUIE, Urgency urinary incontinence episodes. Calibration curves fitted using the rms package, where apparent and bias-corrected curves are smoothed using loess. The bias-corrected curves are adjusted for optimism using bootstrapping with 1000 repetitions in order to correct for overfitting. Rug plots along the top X-axis show the relative prevalence of events at each probability.
Figure 2:
Figure 2:. Associations for Predictors in Prediction Models
A. Adjusted hazard ratios and 95% confidence intervals for each variable in the time to recurrence model over 12 months. B. Adjusted beta coefficients and 95% confidence intervals for each variable in the change in urgency urinary incontinence episode model at 6 months. C. Adjusted odds ratios and 95% confidence intervals for each variable in the self-catheterization model over 6 months. Abbreviations: BoNT-A, onabotulinumtoxinA; UUIE, urgency urinary incontinence episodes; IIQ-SF, Incontinence Impact Questionnaire Short Form. Appropriate ratios or coefficients and 95% confidence intervals for each variable in the three models developed to predict outcomes after OnabotulinumtoxinA. Point estimates are represented by the black dot and 95% confidence intervals are represented by the black bands on either side of the black dot. *: p=0.01-0.05; **: p=0.001-0.01; ***: p<0.001.
Figure 2:
Figure 2:. Associations for Predictors in Prediction Models
A. Adjusted hazard ratios and 95% confidence intervals for each variable in the time to recurrence model over 12 months. B. Adjusted beta coefficients and 95% confidence intervals for each variable in the change in urgency urinary incontinence episode model at 6 months. C. Adjusted odds ratios and 95% confidence intervals for each variable in the self-catheterization model over 6 months. Abbreviations: BoNT-A, onabotulinumtoxinA; UUIE, urgency urinary incontinence episodes; IIQ-SF, Incontinence Impact Questionnaire Short Form. Appropriate ratios or coefficients and 95% confidence intervals for each variable in the three models developed to predict outcomes after OnabotulinumtoxinA. Point estimates are represented by the black dot and 95% confidence intervals are represented by the black bands on either side of the black dot. *: p=0.01-0.05; **: p=0.001-0.01; ***: p<0.001.
Figure 2:
Figure 2:. Associations for Predictors in Prediction Models
A. Adjusted hazard ratios and 95% confidence intervals for each variable in the time to recurrence model over 12 months. B. Adjusted beta coefficients and 95% confidence intervals for each variable in the change in urgency urinary incontinence episode model at 6 months. C. Adjusted odds ratios and 95% confidence intervals for each variable in the self-catheterization model over 6 months. Abbreviations: BoNT-A, onabotulinumtoxinA; UUIE, urgency urinary incontinence episodes; IIQ-SF, Incontinence Impact Questionnaire Short Form. Appropriate ratios or coefficients and 95% confidence intervals for each variable in the three models developed to predict outcomes after OnabotulinumtoxinA. Point estimates are represented by the black dot and 95% confidence intervals are represented by the black bands on either side of the black dot. *: p=0.01-0.05; **: p=0.001-0.01; ***: p<0.001.
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