Outcomes in Patients with Idiopathic Overactive Bladder Undergoing Augmentation Cystoplasty in the Era of Onabotulinumtoxin-A and Interstim
Sood A, Eilender B, Wong P, and Atiemo H. Outcomes in Patients with Idiopathic Overactive Bladder Undergoing Augmentation Cystoplasty in the Era of Onabotulinumtoxin-A and Interstim. Neurourol Urodyn 2019; 38:S238-S239.
Introduction: Idiopathic overactive bladder (iOAB) refractory to conventional first-, second-and third-line therapies is a challenging condition to manage. In this study, we report on contemporary outcomes in patients with refractory iOAB undergoing augmentation cystoplasty. Methods: Medical charts of patients undergoing augmentation cystoplasty for iOAB during the years 2012-2018 were retrospectively reviewed (n=8). All patients were followed for at least 6 months with a median of 12 months. Baseline characteristics including patient demographics, preoperative fluorourodynamic parameters, and first-, second-and third-line iOAB treatments were recorded. Outcomes studied included perioperative outcomes and AUASS (American Urological Association Symptom Score) and ISI (Incontinence Symptom Index) scores. Wilcoxon signed-rank test was used to assess temporal significance; a two-sided p-value Results: The median age of the cohort was 54.5 years. All patients were females. The median preoperative bladder compliance was 39.8 cm H2O and the median preoperative bladder capacity was 134.5 cc. All patients had failed at least 2 drug regimens and had tried-and-failed either treatment with Botox (37.5%) or InterStim (87.5%). The median operative time was 6 hours and 10 minutes; the median blood loss was 150 cc (Table 1). Postoperatively, 2 patients (25%) were voiding spontaneously while others were performing intermittent self-catheterization. There were significant improvements in patient's AUASS and AUASS-QoL scores following surgery (Figure 1a; p=0.032 for each); the ISI and ISI-QoL scores also demonstrated similar temporal trends, however, did not attain statistical significance (Figure 1b; p=0.074 and p=0.057, respectively); the median follow-up was 391 days (IQR: 348 to 494 days). Conclusion: In the current era of Onabotulinumtoxin-A and InterStim as third-line treatments for iOAB patients, augmentation cystoplasty should be considered a fourth-line treatment for the most refractory of patients and is associated with statistically improved symptoms scores.