MP80-13 INTRAVESICAL ONABOTULINUMTOXIN A FOR BLADDER DYSFUNCTION IN “REAL WORLD” CLINICAL PRACTICE
Bibliographic record
Abstract
You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 2014MP80-13 INTRAVESICAL ONABOTULINUMTOXIN A FOR BLADDER DYSFUNCTION IN “REAL WORLD” CLINICAL PRACTICE Richard Baverstock, Bryce Weber, Trafford Crump, Daniel Yanko, and Kevin Carlson Richard BaverstockRichard Baverstock More articles by this author , Bryce WeberBryce Weber More articles by this author , Trafford CrumpTrafford Crump More articles by this author , Daniel YankoDaniel Yanko More articles by this author , and Kevin CarlsonKevin Carlson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2536AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical BOTOX (Onabotulinumtoxin A, BTA) injections for lower urinary tract dysfunction was first described in 1987, and has been used at our institution since 2004. It was approved for use in North America for refractory neurogenic detrusor overactivity (NDO) in 2012, and for idiopathic detrusor overactivity (IDO) in Canada in October 2013. BTA remains off-label for refractory bladder pain syndrome (BPS). Few studies have been published to confirm the long-term safety and efficacy of intravesical BTA, nor the adherence to this form of treatment. We report our long-term “real-world” clinical experience with BTA for refractory bladder storage dysfunction (NDO, IDO, BPS) in our high-volume institution, with attention to baseline data, growth in uptake, and persistence with therapy. METHODS A retrospective chart review of all patients injected between July 20, 2009 (when charts became available via EMR) and October 30, 2013 was performed. RESULTS Overall a total of 1265 injections were performed on 443 unique patients with mean age of 56 years (19 – 88). The majority of patients (66%) were injected under local anesthesia only. The number of BTA treatments ranged from 1 – 14. 63% of patients have received more than 1 injection while 41% have received 3 or more, and 14% 6 or more. Overall, 43% discontinued BTA at any time due to attrition, lack of effect, or change in bladder management. In 2010, 207 injections (17/month) were performed, while 270 were done in 2011 (23/month), and 330 in 2012 (28/month). In the first 10 months of 2013, 377 injections have been performed (38/month). Indications included NDO in 55%, IDO in 40%, BPS in 5%. For the NDO group, 65% were female, compared to 86% of the IDO and 100% of the BPS groups. In the NDO group, 28% had spinal cord injury (SCI), 34% multiple sclerosis (MS), and 38% had other causes. Twenty percent of the entire cohort initiated clean intermittent catheter (CIC), 20% already performed CIC, and 16% had indwelling catheters. No serious adverse events or hospital admissions were observed. CONCLUSIONS Intravesical BTA is a well-tolerated and safe procedure that is performed under local anesthetic in the majority of cases. Repeat treatments are common and popularity of BTA for patients with bladder dysfunction is growing. A significant number of patients initiated CIC in our blended cohort. Persistence with treatment is high, at 57%, despite the challenging nature of the patient population. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e942 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Richard Baverstock More articles by this author Bryce Weber More articles by this author Trafford Crump More articles by this author Daniel Yanko More articles by this author Kevin Carlson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.033 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".