Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI‐RS 2019?

Abstract

Botulinum toxin A (BTX-A) is a well-established treatment for refractory idiopathic overactive bladder (OAB). It has also been used with short-term success in treating idiopathic urinary retention. However, efficacy and complication rates are variable and predicting those likely to benefit most from treatment would enable personalisation of therapy and optimisation of outcomes. At the ICI-RS meeting in 2019 a Think Tank addressed the question of how we can improve the way we phenotype patients undergoing BTX-A treatment. Methods The Think Tank conducted a literature review and expert consensus meeting focussing on how advances in basic science research of the mechanism of action of BTX-A, as well as assessment of psychological comorbidity, can be translated into clinical practice to improve patient selection for therapy. Results Idiopathic OAB and idiopathic urinary retention are heterogenous conditions encompassing several phenotypes with multiple potential pathophysiological mechanisms. Animal models have demonstrated a CNS mechanism of action of intravesically-injected BTX-A and this has been confirmed in human functional MRI studies, but whether this tool can be used to predict outcome from treatment remains to be determined. Phenotyping based on psychological comorbidity using validated screening tools should be studied as a way to potentially optimise patient selection for therapy. Conclusions Advances in basic science research into the mechanism of action of BTX-A have improved our understanding of the pathophysiology of OAB and may lead to novel ways to phenotype patients. Psychological assessment is another way in which phenotyping may be improved. Areas for further research are proposed.

Considering non‐bladder aetiologies of overactive bladder: a functional neuroimaging study

“…These challenges with early identification and prognosis may be reflected in the frequently dissatisfying treatment outcomes [36,37]. Understanding the central processes involved in OAB will strengthen efforts to phenotype patients [37]. As shown in the present study, MR-based neuroimaging is a potent tool to discover the central processes in OAB and their specific differences compared to healthy or non-OAB conditions.…”

“…However, these aetiologies and their differing courses of progression to the full-blown clinical presentation of OAB are not yet fully understood. These challenges with early identification and prognosis may be reflected in the frequently dissatisfying treatment outcomes [36,37]. Understanding the central processes involved in OAB will strengthen efforts to phenotype patients [37].…”

Pharmacological Management of Urinary Incontinence: Current and Emerging Treatment

“…The International Consultation on Incontinence Research Society (ICI-RS) stressed the need for new research exploring OAB phenotyping through urodynamics, functional brain imaging and psychology. 117 43. Griebling…”

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review

“…2 However, many patients either cannot tolerate the side effects of medication or their symptoms are not sufficiently controlled. 3 , 4 , 5 Intradetrusor Botulinum toxin A (BTA) injections have been shown to be very effective in the management of refractory OAB in patients 6 , 7 , 8 , 9 and the procedure is recommended as first‐line treatment for refractory OAB in both idiopathic and neuropathic patients by NICE and EAU. 2 , 10 The procedure can be performed either under local or general anesthetic (GA).…”