138 - The Effect of Intradetrusor OnabotulinumtoxinA on the Upper Urinary Tract in Moderate and High-Risk Neurogenic Bladder Patients: A Comparative Analysis.
Bibliographic record
Abstract
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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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) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".