title: Factors Associated with Therapeutic Efficacy of Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Syndrome.
abstract: OBJECTIVE
  To analyze the predictors of therapeutic efficacy after intravesical botulinum toxin A injection for overactive bladder syndrome (OAB) refractory to antimuscarinic therapy.
  
  
  METHODS
  All consecutively OAB patients, who visited the urologic outpatient clinics of a medical center and refractory to antimuscarinic treatment, were prospectively enrolled. All enrolled patients received intravesical injection of 100 U onabotulinumtoxinA (Botox). The Global Response Assessment (GRA) score ≥ 2 at 3 months after Botox injection was defined as a successful treatment, otherwise failed.
  
  
  RESULTS
  Overall, 89 patients received intravesical injection. Eighty patients, including 42 men and 38 women, had received follow-up at 3 months. The overall success rate was 63.8%. The global response assessment, urgency severity score, urgency, urgency urinary incontinence and frequency episodes, and functional bladder capacity improved after treatment. However, post-void residual volume (PVR) increased, and voiding efficiency (VE) decreased after treatment. Female gender (odds ratio = 3.75) was the only independent factor associated with the success. Female gender (coefficient = 0.74), low baseline overactive bladder symptoms score (coefficient = -0.12) and the presence of OAB-wet (coefficient = 0.79) were independent factors associated with therapeutic efficacy (i.e., GRA score). VE (odds ratio = 0.062) was the only predictor for a large PVR at 3 months. The optimum cutoff value of VE was <87% with the area under the ROC curve being 0.64 (sensitivity = 63.8%, specificity = 57.1%).
  
  
  CONCLUSIONS
  The therapeutic effects of Botox can persist till 6 months after treatment. Female gender, low overactive bladder symptoms score and OAB-wet are associated better therapeutic efficacy, and low baseline VE is associated with large PVR. These findings can serve as an initial guide or assist in consultation regarding the treatment of OAB patients with Botox injection.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01657409.
authors.affiliation: Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan.
authors.forename: Sheng-Mou
authors.initials: SM
authors.lastname: Hsiao
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ho-Hsiung
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D016017:Odds Ratio; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects* / Q000294:innervation / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000503:physiopathology; D014554:Urination / Q000187:drug effects; D014563:Urodynamics / Q000187:drug effects
chemical_list: D065087:Acetylcholine Release Inhibitors; D018727:Muscarinic Antagonists; D019274:Botulinum Toxins, Type A
references.citation: Neurourol Urodyn. 2011 Nov;30(8):1497-502
references.pmid: 21717501
references.citation: J Urol. 2008 Jul;180(1):217-22
references.pmid: 18499184
references.citation: J Formos Med Assoc. 2012 Jul;111(7):386-91
references.pmid: 22817816
references.citation: BJU Int. 2012 Dec;110(11):1767-74
references.pmid: 22409769
references.citation: PLoS One. 2014;9(3):e91609
references.pmid: 24614892
references.citation: Neurourol Urodyn. 2014 Mar;33(3):331-4
references.pmid: 23494586
references.citation: Int J Clin Pract. 2014 Oct;68(10):1246-56
references.pmid: 24754838
references.citation: Neurourol Urodyn. 2015 Sep;34(7):675-8
references.pmid: 24975819
references.citation: Urology. 2000 May;55(5A Suppl):33-46; discussion 50
references.pmid: 10767450
references.citation: BJU Int. 2001 Jun;87(9):774-9
references.pmid: 11412212
references.citation: Neurourol Urodyn. 2002;21(2):167-78
references.pmid: 11857671
references.citation: Urology. 2004 May;63(5):868-72
references.pmid: 15134967
references.citation: J Pharmacol Exp Ther. 1980 Jan;212(1):16-21
references.pmid: 6243359
references.citation: JAMA. 1987 Jun 12;257(22):3076-81
references.pmid: 3586227
references.citation: BJU Int. 1999 Jul;84(1):14-5
references.pmid: 10444116
references.citation: Neurourol Urodyn. 2005;24(3):231-6
references.pmid: 15747344
references.citation: Am J Obstet Gynecol. 2005 May;192(5):1735-40
references.pmid: 15902187
references.citation: J Urol. 2005 Aug;174(2):604-7
references.pmid: 16006914
references.citation: Urology. 2005 Jul;66(1):94-8
references.pmid: 15992869
references.citation: J Urol. 2005 Sep;174(3):977-82; discussion 982-3
references.pmid: 16094018
references.citation: J Urol. 2005 Sep;174(3):984-9
references.pmid: 16094019
references.citation: BJU Int. 2005 Oct;96(6):848-52
references.pmid: 16153215
references.citation: Urology. 2005 Nov;66(5):1005-9
references.pmid: 16286113
references.citation: Urology. 2006 Aug;68(2):318-23
references.pmid: 16904444
references.citation: J Urol. 2007 Jun;177(6):2231-6
references.pmid: 17509328
references.citation: Neurourol Urodyn. 2011 Nov;30(8):1538-40
references.pmid: 21826718