Predicting outcomes after intradetrusor onabotulinumtoxina for non-neurogenic urgency incontinence in women

Whitney K. Hendrickson, Gongbo Xie, David D. Rahn, Cindy L. Amundsen, James A. Hokanson, Megan Bradley, Ariana L. Smith, Vivian W. Sung, Anthony G. Visco, Sheng Luo, J. Eric Jelovsek

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI). Methods: Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months. Model discrimination of Cox and logistic regression models was calculated using c-index. Mean absolute error determined accuracy of the linear model. Calibration was demonstrated using calibration curves. All models were internally validated using bootstrapping. Results: Median time to recurrence was 6 (interquartile range [IQR]: 2–12) months. Increasing age, 200 units of onabotulinumtoxinA, higher body mass index (BMI) and baseline UUIE were associated with decreased time to recurrence. The c-index was 0.63 (95% confidence interval [CI]: 0.59, 0.67). Median change in daily UUIE from baseline at 6 months was −3.5 (IQR: −5.0, −2.3). Increasing age, lower baseline UUIE, 200 units of onabotulinumtoxinA, higher BMI and IIQ-SF were associated with less improvement in UUIE. The mean absolute error predicting change in UUIE was accurate to 1.6 (95% CI: 1.5, 1.7) UUI episodes. The overall rate of self-catheterization was 17.6% (95% CI: 13.6%–22.4%). Lower BMI, 200 units of onabotulinumtoxinA, increased baseline postvoid residual and maximum capacity were associated with higher risk of self-catheterization. The c-index was 0.66 (95% CI: 0.61, 0.76). The three calculators are available at http://riskcalc.duke.edu. Conclusions: After external validation, these models will assist clinicians in providing more accurate estimates of expected treatment outcomes after onabotulinumtoxinA for non-neurogenic UUI in women.

Original languageEnglish (US)
Pages (from-to)432-447
Number of pages16
JournalNeurourology and urodynamics
Volume41
Issue number1
DOIs
StatePublished - Jan 2022

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology

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