Intradetrusor onabotulinumtoxinA (OTA) injection is a well-established treatment option for refractory overactive bladder (OAB), however its use at the time of holmium laser enucleation of the prostate (HoLEP) for men with bladder outlet obstruction (BOO) and storage symptoms has not been previously reported.
We retrospectively identified men with BOO and OAB who underwent treatment with 200U of intradetrusor OTA at the time of HoLEP. Patients were propensity score matched to a cohort of HoLEP-only patients based on age, Michigan Incontinence Symptom Index (M-ISI) score, pre-operative urinary retention, urge incontinence, and prostate size. Perioperative, post-operative, and patient-reported outcomes were examined between groups.
We identified 82 men who underwent HoLEP, including 41 patients in the OTA group and 41 patients in the control group. There was no difference in operative times (59 mins OTA vs 55 mins control, p=0.2), rates of successful same-day TOV (92% OTA vs. 94% control, p=0.7), or rates of same-day discharge (88% OTA vs. 85% control, p=0.6) between groups. There was no difference in temporary post-operative urinary retention (7% OTA vs. 2% control, p=0.3) between groups. Patients who received OTA injections had a significant reduction in their incontinence scores at 3-month follow-up (M-ISI -8, IQR: -13 to 0, p<0.001), while control patients did not (M-ISI -5, IQR: -8 to -1, p=0.2). There was no difference in rates of 90-day complications between groups (OTA 10% vs. control 5%, p=0.7).
Intradetrusor OTA at the time of HoLEP is safe and is associated with improved urinary incontinence scores and AUA Symptom Score (AUASS). Rates of same-day discharge and successful same day TOV after HoLEP were not affected by OTA. These findings support the role of OTA as an adjunct to surgical intervention in men with incontinence related to OAB in the presence of BOO.
Journal of endourology. 2023 Apr 13 [Epub ahead of print]
Mitchell Huang, Nicholas Stewart Dean, Mark A Assmus, Matthew S Lee, Jenny Guo, Amy E Krambeck
Northwestern Medicine, 370076, Urology, Chicago, Illinois, United States; ., Northwestern Medicine, 370076, Urology, 676 N. St. Clair St. Arkes 2300, Chicago, Illinois, United States, 60611-2908; ., Northwestern Medicine, 370076, Urology, Chicago, Illinois, United States., The Ohio State University OSUMC, 12306, Urology, Columbus, Ohio, United States., Northwestern Medicine, 370076, Urology, 676 N St Clair Ste 2300, Chicago, Illinois, United States, 60611; ., Northwestern University School of Medicine, Department of Urology, Chicago, Illinois, United States; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37053094