Preoperative urodynamic factors predicting outcome of botulinum toxin-A intradetrusor injection in children with neurogenic detrusor overactivity

Sang Woon Kim, Jae Hyeok Choi, Yong Seung Lee, Sang Won Han, Young Jae Im

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective To investigate urodynamic (UD) parameters that predict outcome of intradetrusor botulinum toxin-A (BTX-A) injection in children with neurogenic detrusor overactivity (NDO), by reviewing clinical and UD data. Methods From January 2010 to March 2014, 56 cases of the first BTX-A intradetrusor injection were performed in pediatric patients with NDO. We excluded 19 cases based on these criteria: patient age <4 years, no preoperative UD study or postoperative outcome assessment, and simultaneous sphincter injection. Based on the Patient Global Impression of Improvement, patients were classified as responders or nonresponders. Results Thirty-seven cases were included finally. Mean number of pads used per day was significantly decreased after BTX-A injection (2.67 ± 1.46 vs 1.37 ± 1.15; P <.001). On postoperative UD study, maximum cystometric capacity and residual urine volume were significantly increased above baseline. Persistent NDO was only detected in 3 cases (8.1%). Regardless of UD improvements, 20 cases were responders, whereas 17 were nonresponders based on Patient Global Impression of Improvement. Preoperative bladder compliance was significantly lower in nonresponders (25.11 ± 32.59 vs 8.64 ± 6.52; P =.039). Open bladder neck (OBN) was seen in 9 cases and more likely occurred in nonresponders. Regression analysis revealed that poor bladder compliance (<10 mL/cm H2O; odds ratio, 6.041; 95% confidence interval, 1.189-30.677; P = .030) and presence of OBN (odds ratio, 16.889; 95% confidence interval, 1.825-156.282; P = .031) were independent predictors of poor response after BTX-A injection. Conclusion Preoperative bladder compliance and OBN were important predictors of outcome after BTX-A intradetrusor injection. Thus, intradetrusor BTX-A injection should be considered in select patients to achieve optimal outcome.

Original languageEnglish
Pages (from-to)1480-1484
Number of pages5
JournalUrology
Volume84
Issue number6
DOIs
StatePublished - 1 Jan 2014

Fingerprint

Type A Botulinum Toxins
Urodynamics
Urinary Bladder
Injections
Compliance
Odds Ratio
Confidence Intervals
Residual Volume
Regression Analysis
Outcome Assessment (Health Care)
Urine
Pediatrics

Cite this

Kim, Sang Woon ; Choi, Jae Hyeok ; Lee, Yong Seung ; Han, Sang Won ; Im, Young Jae. / Preoperative urodynamic factors predicting outcome of botulinum toxin-A intradetrusor injection in children with neurogenic detrusor overactivity. In: Urology. 2014 ; Vol. 84, No. 6. pp. 1480-1484.
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title = "Preoperative urodynamic factors predicting outcome of botulinum toxin-A intradetrusor injection in children with neurogenic detrusor overactivity",
abstract = "Objective To investigate urodynamic (UD) parameters that predict outcome of intradetrusor botulinum toxin-A (BTX-A) injection in children with neurogenic detrusor overactivity (NDO), by reviewing clinical and UD data. Methods From January 2010 to March 2014, 56 cases of the first BTX-A intradetrusor injection were performed in pediatric patients with NDO. We excluded 19 cases based on these criteria: patient age <4 years, no preoperative UD study or postoperative outcome assessment, and simultaneous sphincter injection. Based on the Patient Global Impression of Improvement, patients were classified as responders or nonresponders. Results Thirty-seven cases were included finally. Mean number of pads used per day was significantly decreased after BTX-A injection (2.67 ± 1.46 vs 1.37 ± 1.15; P <.001). On postoperative UD study, maximum cystometric capacity and residual urine volume were significantly increased above baseline. Persistent NDO was only detected in 3 cases (8.1{\%}). Regardless of UD improvements, 20 cases were responders, whereas 17 were nonresponders based on Patient Global Impression of Improvement. Preoperative bladder compliance was significantly lower in nonresponders (25.11 ± 32.59 vs 8.64 ± 6.52; P =.039). Open bladder neck (OBN) was seen in 9 cases and more likely occurred in nonresponders. Regression analysis revealed that poor bladder compliance (<10 mL/cm H2O; odds ratio, 6.041; 95{\%} confidence interval, 1.189-30.677; P = .030) and presence of OBN (odds ratio, 16.889; 95{\%} confidence interval, 1.825-156.282; P = .031) were independent predictors of poor response after BTX-A injection. Conclusion Preoperative bladder compliance and OBN were important predictors of outcome after BTX-A intradetrusor injection. Thus, intradetrusor BTX-A injection should be considered in select patients to achieve optimal outcome.",
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Preoperative urodynamic factors predicting outcome of botulinum toxin-A intradetrusor injection in children with neurogenic detrusor overactivity. / Kim, Sang Woon; Choi, Jae Hyeok; Lee, Yong Seung; Han, Sang Won; Im, Young Jae.

In: Urology, Vol. 84, No. 6, 01.01.2014, p. 1480-1484.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative urodynamic factors predicting outcome of botulinum toxin-A intradetrusor injection in children with neurogenic detrusor overactivity

AU - Kim, Sang Woon

AU - Choi, Jae Hyeok

AU - Lee, Yong Seung

AU - Han, Sang Won

AU - Im, Young Jae

PY - 2014/1/1

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N2 - Objective To investigate urodynamic (UD) parameters that predict outcome of intradetrusor botulinum toxin-A (BTX-A) injection in children with neurogenic detrusor overactivity (NDO), by reviewing clinical and UD data. Methods From January 2010 to March 2014, 56 cases of the first BTX-A intradetrusor injection were performed in pediatric patients with NDO. We excluded 19 cases based on these criteria: patient age <4 years, no preoperative UD study or postoperative outcome assessment, and simultaneous sphincter injection. Based on the Patient Global Impression of Improvement, patients were classified as responders or nonresponders. Results Thirty-seven cases were included finally. Mean number of pads used per day was significantly decreased after BTX-A injection (2.67 ± 1.46 vs 1.37 ± 1.15; P <.001). On postoperative UD study, maximum cystometric capacity and residual urine volume were significantly increased above baseline. Persistent NDO was only detected in 3 cases (8.1%). Regardless of UD improvements, 20 cases were responders, whereas 17 were nonresponders based on Patient Global Impression of Improvement. Preoperative bladder compliance was significantly lower in nonresponders (25.11 ± 32.59 vs 8.64 ± 6.52; P =.039). Open bladder neck (OBN) was seen in 9 cases and more likely occurred in nonresponders. Regression analysis revealed that poor bladder compliance (<10 mL/cm H2O; odds ratio, 6.041; 95% confidence interval, 1.189-30.677; P = .030) and presence of OBN (odds ratio, 16.889; 95% confidence interval, 1.825-156.282; P = .031) were independent predictors of poor response after BTX-A injection. Conclusion Preoperative bladder compliance and OBN were important predictors of outcome after BTX-A intradetrusor injection. Thus, intradetrusor BTX-A injection should be considered in select patients to achieve optimal outcome.

AB - Objective To investigate urodynamic (UD) parameters that predict outcome of intradetrusor botulinum toxin-A (BTX-A) injection in children with neurogenic detrusor overactivity (NDO), by reviewing clinical and UD data. Methods From January 2010 to March 2014, 56 cases of the first BTX-A intradetrusor injection were performed in pediatric patients with NDO. We excluded 19 cases based on these criteria: patient age <4 years, no preoperative UD study or postoperative outcome assessment, and simultaneous sphincter injection. Based on the Patient Global Impression of Improvement, patients were classified as responders or nonresponders. Results Thirty-seven cases were included finally. Mean number of pads used per day was significantly decreased after BTX-A injection (2.67 ± 1.46 vs 1.37 ± 1.15; P <.001). On postoperative UD study, maximum cystometric capacity and residual urine volume were significantly increased above baseline. Persistent NDO was only detected in 3 cases (8.1%). Regardless of UD improvements, 20 cases were responders, whereas 17 were nonresponders based on Patient Global Impression of Improvement. Preoperative bladder compliance was significantly lower in nonresponders (25.11 ± 32.59 vs 8.64 ± 6.52; P =.039). Open bladder neck (OBN) was seen in 9 cases and more likely occurred in nonresponders. Regression analysis revealed that poor bladder compliance (<10 mL/cm H2O; odds ratio, 6.041; 95% confidence interval, 1.189-30.677; P = .030) and presence of OBN (odds ratio, 16.889; 95% confidence interval, 1.825-156.282; P = .031) were independent predictors of poor response after BTX-A injection. Conclusion Preoperative bladder compliance and OBN were important predictors of outcome after BTX-A intradetrusor injection. Thus, intradetrusor BTX-A injection should be considered in select patients to achieve optimal outcome.

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