Presentation Authors: Rita Jen*, Irene Crescenze, Anne Cameron, Paholo Barboglio-Romo, Priyanka Gupta, Bahaa Malaeb, John Stoffel, Quentin Clemens, Ann Arbor, MI
Introduction: In 2011 the FDA approved onabotulinum toxin A (BTX-A) in patients with NGB. This allowed for patients refractory to medical therapy an alternative to proceeding directly to augmentation cystoplasty or urinary diversion. We sought to identify the impact BTX-A had on augmentation and diversion rates over the last 11 years. We hypothesize that the less morbid BTX-A led to a decline in rates of bladder augmentation and diversion for patients with NGB.
Methods: The number of bladder augmentations, diversions, and BTX-A injections performed per year for the last 11 years at a single institution were identified retrospectively and adjusted based on number of NGB patient visits. Patients with prior pelvic radiation, cancer in the pelvis, revision bladder surgery, and isolated continence channels were excluded.
Results: There were 3303 patients with NGB diagnoses evaluated at 9867 distinct encounters at a single center over 11 years and 156 patients who underwent either bladder augmentation or incontinent diversion for NGB. The cohort was 58.3% (91/156) female. Median age was 45 years (18-80). Seventy patients underwent bladder augmentation ranging 4-10 per year and 86 underwent diversions ranging 4-12 per year (Figure 1). After adjusting for the total number of NGB patients seen by urology each year, the odds of having augmentation in 2015-2017 vs. 2007-2009 was 0.37 (95%CI 0.20-0.72, p=0.003) and odds of having an incontinent diversion was 0.55 (95%CI 0.30-0.995, p=0.048) (Figure 2). The proportion of visits for BTX-A injections in the total NGB cohort increased from 10.46% (55/526) in 2012 to 21.92% (217/990) in 2017 (OR=2.40, 95%CI 1.75-3.30, p < 0.001). Increased number of patients failed BTX-A prior to surgery in 2015-2017 vs. 2007-2009 (47.2% vs. 10.6%, OR7.5, 95%CI 2.42-23.4, p < 0.001).
Conclusions: The rates of augmentation and incontinent diversion are declining while rates of BTX-A therapy are increasing over the past decade. More data are needed to determine if BTX-A represents a permanent or only a temporary solution for management of NGB.