PD39-11 PREDICTORS OF URINARY RETENTION IN MALE PATIENTS RECEIVING INTRADETRUSOR BOTULINUM TOXIN INJECTIONS

摘要

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction III1 Apr 2017PD39-11 PREDICTORS OF URINARY RETENTION IN MALE PATIENTS RECEIVING INTRADETRUSOR BOTULINUM TOXIN INJECTIONS Daniel Hoffman, Ekene Enemchukwu, and Victor Nitti Daniel HoffmanDaniel Hoffman More articles by this author , Ekene EnemchukwuEkene Enemchukwu More articles by this author , and Victor NittiVictor Nitti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1738AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intradetrusor onabotulinumtoxinA (BTX-A) BTX-A injections are an established third-line therapy for the treatment of overactive bladder (OAB). Incomplete bladder emptying requiring clean intermittent catheterization (CIC) is a side effect that limits patient acceptability of BTX-A. There are studies that have evaluated risk factors that predispose to need for CIC, but few have looked at parameters that may confer protection against CIC. Herein we present an initial report of a cohort of men who have undergone prostatectomy and subsequent BTX-A for OAB. METHODS A retrospective chart review of patients receiving BTX-A for OAB refractory to antimuscarinics and/or beta 3agonists from 2010 to 2016 was performed. We sought to identify predictors of elevated post-void residual (PVR) leading to CIC in patients not expected to CIC post treatment. A subset of men who had undergone prostatectomy for benign or malignant disease (open or robotic radical prostatectomy (RP), or transurethral procedure (TUR) for BPH were identified. All men received 100 units of onabotulinumtoxinA under local anesthesia by flexible cystoscope. PVR was measured 2 weeks after the procedure. We generally recommend CIC for PVR 200 - 349 ml with symptoms or greater than 350mL with or without symptoms. Clinical variables were correlated with PVR/CIC at their subsequent evaluations. Patients with neurogenic DO and those performing CIC prior to BTX-A injection were excluded. RESULTS 71 men were identified. Of these, 45 (63.4%) had surgical interventions on their prostate; 23 (32.4 %) had open or robotic RP and 22 (31 %) had a TUR for BPH. The overall rate of CIC was 12.7%. Three (13.6%) men in the TUR group required CIC vs. 6 (23%) who had an intact prostate No men in the RP group required CIC. The median post BTX-A PVR in the RP group was 44 ml when compared to 104 in the TUR group and 197ml in the group with intact prostates. (Table) CONCLUSIONS The rate of CIC in men receiving BTX-A for OAB in our cohort was 12.7%, somewhat higher than is seen in women. Prior RP appears to have a protective effect against CIC (p=0.02) and elevation of PVR (p=0.001). No man required CIC after RP. Prior TUR does not confer protection against CIC (p=0.5) but may protect against elevation of PVR (p=.03). A proposed mechanism for better emptying after surgery may be the ability to Valsalva void. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e749 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Daniel Hoffman More articles by this author Ekene Enemchukwu More articles by this author Victor Nitti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...