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AUA 2019

AUA 2019: The Impact of Frailty on the Treatment of Overactive Bladder in Older Adults

Chicago, IL (UroToday.com) This podium session included several studies evaluating different aspects of the treatment of overactive bladder (OAB). This study, presented by Dr. Kowalik, focused specifically on treatment of OAB in older adults. Previous literature has demonstrated that frailty is associated with OAB in older adults.1 Frailty has also predicted worse outcomes after surgery, though it remains unclear if frailty affects treatment outcomes in OAB. Furthermore, the authors note that most clinical trials exclude frail individuals. The goal of this study was to evaluate the effect of frailty on the treatment of OAB with medications, onabotulinumtoxinA (BTX-A), and sacral neuromodulation (SNM).

The authors performed a multi-institutional, prospective study of subjects over the age of 60 with OAB who were starting medication or receiving BTX-A or SNM. Frailty was measured using the timed up-and-go test. This is a simple test where the patient is asked to get up from a chair, walk 10 feet, turn around, walk back and sit down in the chair. Patients were considered to be frail if the timed up and go took 12 seconds or longer. They also assessed frailty with ADL questionnaires. Outcomes of pharmacotherapy, BTX-A, and SNM were measured using OAB symptom score (OABSS), the OAB-q SF. Subjects were compared in two groups, frail (timed up and go ³ 12) and not frail (timed up and go < 12). Outcomes were measured at baseline, 1, and 3 months.

The study enrolled 45 subjects, 40% of whom were considered frail. One-month assessment was completed by 38 subjects, and three-month assessment by 33 subjects. Baseline assessment of the two groups showed differences on in the incidence of neurogenic bladder, which was higher in the frail group. For pharmacotherapy, BTX-A, and SNM both groups demonstrated significant improvement in OAB, and there was no difference in improvement between the two groups. In addition, side effects and adverse events were similar between groups.

Overall, this is a very interesting and timely study exploring the important issue of frailty in treating pelvic floor disorders. While many clinicians may be hesitant to provide medication or third line therapy to frail older patients, this study demonstrates that these treatments can be both safe and effective. Although the number of subjects in this study is small, the information is clinically applicable to most urology practices. The authors conclude that second- and third- line therapy should be considered even for frail older patients with OAB.

Presented by: Casey Kowalik, MD, The University of Kansas Medical Center

Written by: Dena Moskowitz, MD; Assistant Professor of Clinical Urology, University of California Irvine; @demoskowitz at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

Reference:
  1. Suskind AM, Quanstrom K, Zhao S, et al. Overactive bladder is strongly associated with frailty in older individuals. Urology. 2017;106:26-31. doi:10.1016/j.urology.2017.03.058