The Use of Onabotulinumtoxina for Treatment of Detrusor Overactivity in Older Patients

Objective: To evaluate the outcomes of intra-detrusor OnabotulinumtoxinA for the treatment of Detrusor Overactivity (DO) in patients both over and under the age of 70. Our primary end points were subjective improvement, UTI and urinary retention after treatment. Materials and Methods: A retrospective chart review of 85 male and female patients who received intra detrusor onabotulinumtoxinA for the treatment of DO was conducted. The data was analyzed by fitting generalized linear mixed models using the package ‘lme4' in R. We examined the association between age over 70 years, Pelvic Organ Prolapse (POP), Neurogenic Detrusor Overactivity (NDO), catheter use, and type II diabetes (DM), with post-injection subjective improvement, Urinary Tract Infection (UTI), and retention. Results: Subjective Improvement: Odds of reporting improvement are 83% lower in people over the age of 70 (95% CI [22%, 96%]). Odds of reporting improvement are 3.8 times higher in those with DM compared to those without DM (95% CI [0.73, 46]). Post Injection UTI: Odds of UTI are 7.6 times higher in those with NDO than in those without NGB (95% CI [1.2, 47.0]). Odds of UTI are 5.9 times greater in patient's = 70 than in those under 70 years old (95% CI [0.99, 35]). Urinary retention: No significant associations were found. Conclusion: Intra-detrusor onabotulinumtoxinA is safe and effective for patient's = 70 however they are less likely to report subjective improvement of their urgency incontinence symptoms and are more likely to experience UTI after treatment than patients less than 70 years of age. These findings allow for improved counseling of older patients regarding their associated treatment risks and likelihood of symptom improvement.