ABSTRACT Introduction We investigated demographic, diagnostic, and socioeconomic variables associated with continuation and discontinuation of onabotulinum toxin (BTX) therapy in adult patients treated for idiopathic and neurogenic urgency urinary incontinence (UUI). Methods Patients who initiated BTX for UUI between 2015 and 2018 at a tertiary academic referral center were identified from CPT codes and followed through 2020 ( n = 723). The cohort was divided into patients who continued BTX therapy (received ≥1 BTX treatment within 2 years of initial injection) (Group A), and patients who stopped BTX (received no additional BTX for at least 2 years after the last injection) (Group B). Demographic variables were extracted using chart review and administrative data. Socioeconomic differences were estimated using affluence index (AI) and disadvantage index (DI) from their last botox injection, calculated using U.S. census tract indicators. AI factors include household income, professions of household members, and educational background. DI factors include neighborhood proportion of female‐headed households, receiving public assistance or not, household income level, and level of employment. Indexes ranged from 0.0 (least affluent or disadvantaged) to 1.0 (most affluent or advantaged). Results The mean cohort age ( n = 723) was 57% and 69% were female. After the initial injection, 40% received additional injections within 2 years (Group A) and 60% did not (Group B). There were no demographic differences between groups. Univariate comparison of affluence and disadvantage indexes revealed Group A affluence was not significantly different (AI = 0.38 vs 0.37, p = 0.2) but was slightly less disadvantaged (DI = 0.072, vs. 0.081; p = 0.036) than Group B. Multivariable analysis including demographic and socioeconomic factors demonstrated that higher affluence index was associated with lower odds of BTX discontinuation (OR = 0.90 per 0.1‐unit increase, 95% CI: 0.82–0.99, p = 0.029), while there was insufficient evidence of an association between disadvantage index and discontinuation (OR = 1.23 per 0.1‐unit increase, 95% CI: 0.99–1.54, p = 0.06). After adding neurogenic versus non‐neurogenic etiology of UUI, the socioeconomic associations were no longer significant. Patients with a non‐neurogenic diagnosis had significantly greater odds of BTX discontinuation than patients with a neurogenic diagnosis (OR = 1.97, 95% CI: 1.35–2.89, p < 0.001). Conclusion Approximately 40% of patients continued BTX treatment for UUI beyond the initial injection period. Neurogenic diagnosis was strongly associated with treatment persistence, with non‐neurogenic patients demonstrating greater odds of discontinuation. Socioeconomic factors were not independently associated with discontinuation after adjustment for clinical diagnosis. Clinical Trial Registration This is a retrospective study with IRB approval. This study is not a clinical trial and will not be registered as a clinical trial.
Objectives This study aimed to evaluate the distribution and intensity of intraprocedural pain during intradetrusor onabotulinumtoxinA injections by assessing differences across anatomical bladder regions and diagnostic subgroups. Specifically, the study investigated whether pain perception varied based on gender, diagnosis, and injection site in patients with idiopathic detrusor overactivity (IDO), neurogenic detrusor overactivity (NDO), and wet overactive bladder (OAB-wet). Methods In this prospective observational study, 119 adult patients who underwent intradetrusor onabotulinumtoxinA injections between March 2021 and October 2023 were included. Patients were diagnosed with IDO, NDO, or OAB-wet. All procedures were performed using flexible cystoscopy under local anesthesia with Optilube gel. A standardized 20-site injection protocol was used, including two injections on each lateral wall, five in the para-trigonal region, and 11 in randomly distributed sites on the anterior and posterior bladder walls. Patients reported their pain scores for each region using a 0-10 visual analog scale (VAS). A control group of 50 patients undergoing diagnostic flexible cystoscopy provided baseline pain scores. Two-way ANOVA was used to assess differences in pain scores based on gender, diagnosis, and anatomical region. Results A total of 119 patients (82 females, 37 males) were included, with 88 diagnosed with IDO, 28 with NDO, and 3 with OAB-wet. The mean overall VAS pain score during BoNT-A injections was 4.03 +/- 1.21, compared to 1.76 +/- 0.68 in 50 patients undergoing diagnostic flexible cystoscopy (p < 0.001). Among injection sites, mean scores were 3.78 for para-trigonal, 4.03 for lateral wall, and 3.11 for randomly distributed regions. Two-way ANOVA showed no significant differences in pain scores by gender or diagnosis, except for para-trigonal pain, which was higher in OAB-wet patients (p = 0.01). Excluding this subgroup, no significant difference remained between IDO and NDO (p = 0.06). Conclusions Intravesical onabotulinumtoxinA injections are generally well tolerated under local anesthesia, though para-trigonal injections may cause greater discomfort, particularly in patients with OAB-wet. While pain perception did not differ significantly by gender or diagnosis overall, region-specific sensitivity should be considered when planning injection techniques. These findings may help inform strategies to improve procedural comfort and support individualized treatment approaches. Trial Registration This study was not registered as a clinical trial because it was a non-randomized, observational study without prospective assignment or intervention groups, consistent with ICMJE criteria.
Aims The aim of this RCT is to compare the efficacy of sacral transcutaneous electrical nerve stimulation (TENS) with oxybutynin in children with overactive bladder (OAB), focusing on subjective & objective treatment response, adverse effects, and relapse rates.Materials and Methods In this prospective randomized controlled study, 82 children aged 5-18 years with refractory OAB were randomized to receive either sacral TENS (30 sessions; 20 min each (10 Hz) daily; for 4 weeks) or oral oxybutynin (0.2 mg/kg/day for 4 weeks). Outcomes were assessed using subjective response categories based on bladder diaries and objective measures including the Overactive Bladder Index (OABI) and Dysfunctional Voiding Symptom Score (DVSS). Adverse effects and relapse during 6-12 months of follow-up were recorded.Results There was no significant difference between age/sex distributions between the groups. Median follow-up was 9 (6-12) months. Complete response was significantly higher with TENS than oxybutynin (68.3% vs. 31.7%; OR 4.63, 95% CI 1.8-11.7; p = 0.001). Mean improvement in OABI (4.6 +/- 1.4 vs. 3.7 +/- 1.0; p = 0.001) and DVSS (8.8 +/- 1.5 vs. 5.7 +/- 1.3; p = 0.001) favored TENS. Adverse effects (4.9% vs. 46.3%) and relapse rates (7.3% vs. 29.3%) were significantly lower with TENS.Conclusion Sacral TENS was associated with higher response rates and fewer adverse effects than oxybutynin in this cohort supporting its role as an effective and well-tolerated therapeutic option for pediatric OAB. Further larger trials are warranted.
