138 - The Effect of Intradetrusor OnabotulinumtoxinA on the Upper Urinary Tract in Moderate and High-Risk Neurogenic Bladder Patients: A Comparative Analysis.
Notice bibliographique
Résumé
Hypothesis / aims of study Both the American Urological Association (AUA) and the Canadian Urological Association (CUA) endorse a risk-stratification and surveillance protocol for neurogenic lower urinary tract dysfunction (NLUTD), categorizing patients into low-, moderate-, and high-risk groups with tailored monitoring. This study evaluated whether intravesical OnabotulinumtoxinA (BTX-A) impacts upper urinary tract (UUT) parameters differently in moderate- vs. high-risk patients. Study design, materials and methods We conducted a retrospective analysis (January 2017–January 2023) of all adult NLUTD patients who received BTX-A injections. Inclusion criteria required ≥2 years of follow-up with serum creatinine, GFR, and renal ultrasound assessments. Pediatric and low-risk patients were excluded. The primary outcome was to compare the effect of BTX-A on serum creatinine, GFR, hydronephrosis (HN), and vesicoureteral reflux (VUR) between the two groups. Secondary outcomes were to evaluate the impact of BTX-A injection on UTI incidence, BTX-A dose adjustments, self-catheterization frequency and to determine whether correlations exist between BTX-A injection results and urodynamic parameters (bladder capacity, neurogenic detrusor overactivity [NDO], compliance, DLPP), or pharmacotherapy regimens. Statistical analyses included paired t-tests, chi-square, and multivariate regression. Results We found 74 patients (mean age 36.8 ± 12.2 years, 47.3% male, 52.7% female), with etiologies including spinal cord injury (n= 32, 43.2%), multiple sclerosis (n= 14, 18.9%), meningomyelocele (n= 4, 5.4%), disc disease (n=22, 29.7%), and others (n= 2, 2.8%). BTX-A significantly improved serum creatinine (p= 0.008), and hydronephrosis (p< 0.001). GFR increased (+21.5 vs. +10.2 mL/min, p= 0.016). High-risk patients showed more significant improvement in serum creatinine and GFR than moderate-risk ones (creatinine improved: 75.9% vs 35.6%, p< 0.001), (GFR increased: +21.5 mL/min vs. +10.2 mL/min). Hydronephrosis improved post-BTX-A more in high-risk compared to moderate-risk patients (68% vs 58%, p= 0.04). Urinary tract infections were reduced more after BTX-A injection in high-risk compared to moderate-risk patients (76% vs. 40%, p< 0.05). A statistically significant association was observed between female gender and greater improvement in hydronephrosis following BTX-A treatment (p= 0.03). Patients with spinal cord injury demonstrated the most substantial reduction in serum creatinine levels post-BTX-A when compared to other diagnostic groups (p= 0.02). Those receiving combination therapy showed a trend toward more frequent hydronephrosis improvement than patients on monotherapy (65% versus 50%, p= 0.08). Urodynamic assessment revealed that normal bladder capacity served as a predictor for creatinine improvement (OR= 2.4, p= 0.01), while the absence of neurogenic detrusor overactivity (NDO) was correlated with enhanced GFR outcomes (OR= 1.9, p= 0.03). When analyzing dose adjustments and excluding patients who started with 300 IU, 22% of moderate-risk patients versus 35% of high-risk patients required dose escalation in subsequent injections (p= 0.09). Furthermore, patients exhibiting improved GFR after BTX-A treatment demonstrated a significant tendency to reduce their daily self-catheterization frequency (p= 0.01). Interpretation of results OnabotulinumtoxinA (BTX-A) demonstrated significant improvement in upper urinary tract (UUT) parameters and reduction in urinary tract infection (UTI) rates, with these therapeutic effects being particularly pronounced in high-risk neurogenic bladder patients. Urodynamic characteristics, including normal bladder capacity and absence of neurogenic detrusor overactivity (NDO), could be potential predictive factors for positive BTX-A response. These findings support the clinical utility of the current risk stratification and surveillance protocol, particularly for detecting patients at elevated risk of UUT deterioration. The interpretation of these results should consider the study's limitations, including its retrospective nature and relatively small cohort size. Concluding message BTX-A effectively stabilizes UUT function in NLUTD patients, with effects being particularly evident in high-risk patients. Pre-BTX-A urodynamic parameters may predict therapeutic response to BTX-A, while UUT imaging surveillance protocol possibly would optimize outcomes. These findings substantiate the clinical relevance of the existing risk stratification system of neurogenic bladder. However, prospective studies are necessary to validate these findings. Download: Download high-res image (73KB) Download: Download full-size image Figure 1 . Effect of BTX-A on UUT in all patients and moderate vs high-risk NGB patients Download: Download high-res image (66KB) Download: Download full-size image Figure 2 . Effect of BTX-A on serum creatinine and GFR in moderate vs high-risk NGB patients Download: Download high-res image (43KB) Download: Download full-size image Figure 3 . UTI rate post-BTX-A: moderate vs high-risk NGB patients Funding nil Clinical Trial No Subjects Human Ethics Committee KFSH-D Ethical Committee Helsinki Yes Informed Consent Yes
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».