Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI-RS 2019?

Sachin Malde*, Apostolos Apostilidis, Caroline Selai, Mohammad Sajjad Rahnama'i, Tom Marcelissen, Linda Cardozo, Thelma Lovick

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

3 Citations (Web of Science)

Abstract

Aims Botulinum toxin A (BTX-A) is a well-established treatment for refractory idiopathic overactive bladder (OAB). It has also been used with short-term success in treating idiopathic urinary retention. However, efficacy and complication rates are variable and predicting those likely to benefit most from treatment would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society (ICI-RS) meeting in 2019 a Think Tank addressed the question of how we can improve the way we phenotype patients undergoing BTX-A treatment. Methods The Think Tank conducted a literature review and expert consensus meeting focussing on how advances in basic science research of the mechanism of action of BTX-A, as well as assessment of psychological comorbidity, can be translated into clinical practice to improve patient selection for therapy. Results Idiopathic OAB and idiopathic urinary retention are heterogenous conditions encompassing several phenotypes with multiple potential pathophysiological mechanisms. Animal models have demonstrated a central nervous system mechanism of action of intravesically injected BTX-A and this has been confirmed in human functional MRI studies, but whether this tool can be used to predict outcome from treatment remains to be determined. Phenotyping based on psychological comorbidity using validated screening tools should be studied as a way to potentially optimize patient selection for therapy. Conclusions Advances in basic science research into the mechanism of action of BTX-A have improved our understanding of the pathophysiology of OAB and may lead to novel ways to phenotype patients. Psychological assessment is another way in which phenotyping may be improved. Areas for further research are proposed.

Original languageEnglish
Pages (from-to)S104-S112
Number of pages9
JournalNeurourology and Urodynamics
Volume39
Issue numberS3
Early online date6 Nov 2019
DOIs
Publication statusPublished - Jul 2020

Keywords

  • Botulinum toxin
  • overactive bladder
  • urinary retention
  • phenotype
  • OVERACTIVE BLADDER SYMPTOMS
  • URETHRAL SPHINCTER
  • DETRUSOR OVERACTIVITY
  • ABDUCENS MOTONEURONS
  • DOUBLE-BLIND
  • WOMEN
  • NEUROTOXIN
  • DYSFUNCTION
  • ONABOTULINUMTOXINA
  • DEPRESSION

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