Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder

Barba, Marta; Lazar, Tetyana; Cola, Alice; Marino, Giuseppe; Manodoro, Stefano; Frigerio, Matteo

doi:10.2147/ijwh.s345454

Cited by 9 publications

(8 citation statements)

References 23 publications

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“…Rates of CIC requirement after BTX-A injection into the bladder are highly variable, ranging from 4% to 45% of cases. In other worldwide clinical trials, the mean CIC rate was approximately 23% of cases [21,22].…”

Section: Discussionmentioning

confidence: 88%

Variability of urodynamic parameters in patients with idiopathic overactive bladder before intradetrusor botulinum toxin injections

Ivanov¹,

Ceban²

2022

MJHS

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Introduction. The aim of study was to establish if the treatment of overactive bladder in women and its result reported by patients were different depending on the findings of urodynamics, performed before botulinum toxin injection. We obtained clinical data based on the necessity and importance of performing urodynamic tests up to surgical treatment with botulinum toxin A injection in detrusor muscle, at patients diagnosed with idiopathic overactive bladder and detrusor overactivity, offering a guarantee of an effective and long-lasting treatment and assure with predictive parameters for some postoperative complications. Material and methods. The research was carried out at the Department of Urology and Surgical Nephrology, during the years 2019 – 2022. After applying the inclusion and exclusion criteria, 36 women diagnosed with overactive bladder were enrolled in the prospective pilot study, aged between 18 and 70 years, refractory to drug treatment and investigated urodynamic by excluding/including the presence of detrusor overactivity and clinically using voiding diary/24h, bladder symptoms and Quality of Life questionnaires before and after botulinum toxin A injection. The primary data were analyzed and presented as a mean and standard deviation. Results. All women involved in the study were diagnosed clinically and urodynamic with overactive bladder, of which 55.5% of cases were associated with detrusor overactivity and subsequently received BTX-A injectable surgical treatment with a dose of 100U. At urodynamics, the low values of the indices obtained at cystometry were established: first sensation of bladder filling (79.8 ± 56.3 ml), first desire to void (117.8 ± 103.2 ml), strong desire to void (162 ± 125 ml) and maximal cystometric capacity (183.4 ± 139.8 ml), which correlated in 100% cases with OAB symptoms (urinary urgency, frequency and nocturia) from the OABSS validated questionnaire. The capacity of the bladder at each sensation was lower, being inversely proportional to the detrusor overactivity present in women with OAB. Based on UDS data, the diagnosis of OABi with detrusor overactivity was confirmed by establishing the presence of phasic detrusor contractions (3.9 ± 1.1), increased values of detrusor pressure (45.9 ± 23.9 cmH2O) and the presence of bladder hypocompliance (10.6 ± 11.5 ml/cmH2O), these data in 100% of cases predicted an effective BTX-A injection. Daily activity and psychosocial behavior improved after intradetrusor botulinum injections toxin was influenced by reducing daytime urination from 28% to 40% and urinary urgency from 30 to 69%. Conclusions. This study identified a number of statistically significant urodynamic variables associated with objective clinical data, which confirm the impact of severity of idiopathic overactive bladder symptoms and the subsequent effect of botulinum toxin type A injections in case of urodynamic confirmation of detrusor overactivity presence.

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Section: Discussionmentioning

confidence: 88%

Variability of urodynamic parameters in patients with idiopathic overactive bladder before intradetrusor botulinum toxin injections

Ivanov¹,

Ceban²

2022

MJHS

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“…To this day, no study has investigated the effect of the number of interventions per surgeon per year on patient outcomes or surgical failure and complication rates regarding BoNT. Barba et al investigated the learning curve in residents and only found improvements for operative time, subjective easiness, and perceived tolerability [ 13 ]. No improvements were found concerning the number of valid injections or complications.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Techniques for the Use of Botulinum Toxin in Overactive Bladder: Results of a Multinational Online Survey of Urogynecologists in Germany, Austria, and Switzerland

Lange

Koch

Lange

et al. 2023

JCM

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Introduction and Hypothesis: Botulinum toxin (BoNT) is a widely used treatment for overactive bladder (OAB). Despite its common use, no standardized treatment regimen exists so far. The aim of this survey was to evaluate the variation in perioperative treatment strategies among members of the German-speaking urogynecologic societies. Materials and Methods: A clinical practice online survey was carried out between May 2021 and May 2022, and all members of the German, Swiss, and Austrian urogynecologic societies were invited to participate. Participants were grouped in two ways. First, they were grouped into (1) urogynecologists with board certification and (2) non-board-certified general obstetricians and gynecologists (OBGYNs). Second, we set a cut-off at 20 transurethral BoNT procedures per year to differentiate between (1) high- and (2) low-volume surgeons. Results: One hundred and six completed questionnaires were received. Our results demonstrated that BoNT is mostly used as a third-line treatment (93%, n = 98/106), while high-volume surgeons used it significantly more often as a first/second-line treatment (21% vs. 6%, p = 0.029). Large variations existed in the use of perioperative antibiotics, preferred sites of injection, the number of injections, and the timing of the measurement of the postvoid residual volume (PVRV). Forty percent of participants did not offer outpatient treatment to patients. Local anesthesia (LA) was mostly used by board-certified urogynecologists (49% vs. 10%, p < 0.001) and high-volume surgeons (58% vs. 27%, p = 0.002). Injections into the trigone were also more often performed by board-certified urogynecologists and high-volume surgeons (22% vs. 3% (p = 0.023) and 35% vs. 6% (p < 0.001), respectively). PVRV was controlled between weeks 1 and 4 by only 54% of participants (n = 57/106). Clean intermittent self-catheterization (CISC) was infrequently taught (26%). Conclusions: Our survey confirmed that BoNT is widely used by urogynecologists in the three German-speaking countries, but practice patterns vary widely, and no standardized method could be detected, despite interviewing urogynecologic experts. These results clearly demonstrate that there is a need for studies to define standardized treatment strategies for the best perioperative and surgical approach regarding the use of BoNT in patients with OAB.

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“…Many factors contribute to whether a physician is able to perform a particular medical procedure, including the extent of specific training and skills, which can be considered as an extension of the concept of experience. Recently, there has been great interest in the evaluation of the impact of the degree of experience in terms of the proficiency of medical procedures [ 8 , 9 ]. Learning curves graphically meet this need by representing the impacts of the repetitive task over a defined period, in terms of proficiency parameters, such as duration of procedure, difficulty and grade of autonomy.…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, there is a growing literature on the learning curves in urology and female pelvic floor medicine. For instance, there are some reports on operative cystoscopy for botulinum toxin bladder injections and transurethral resection of the prostate, which showed excellent safety and efficiency even at the beginning of the learning curve [ 9 , 10 , 11 ]. Similar experiences have been published regarding the surgical management of stress urinary incontinence with midurethral slings [ 8 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

The Learning Curve of Urodynamics for the Evaluation of Lower Urinary Tract Symptoms

et al. 2022

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Background and Objectives: Urodynamics is considered the gold standard for lower urinary tract functional assessment. However, it requires very specific skills and training, which are currently difficult to master due to its reduced use. Moreover, no studies or data are available to define the workload and the learning curve of this diagnostic tool. As a consequence, we aimed to evaluate the learning curve of residents with no previous experience to correctly perform and interpret urodynamics, and properly address and manage patients with pelvic floor disorders based on urodynamics findings. Materials and Methods: This prospective study analyzed a series of proficiency parameters in residents performing urodynamics under consultant supervision, including the following: duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and therapeutic proposal. The number of procedures performed was then divided into groups of five to evaluate the progressive grade of autonomy (technical and full management autonomy) reached by each resident. Results: In total, 69 patients underwent urodynamics performed by three residents, with every resident performing at least 20 exams. Duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and the appropriateness of the hypothetical proposal of management/treatment based on their interpretation of clinical data and urodynamic findings was shown to be directly related to the number of exams performed. Technical autonomy in the execution of uroflowmetry was reached in the group performing 6–10 procedures, while technical autonomy in the execution of cystomanometry with pressure/flow study was obtained in the group of 16–20 procedures. The latter corresponded also to the gain of full autonomy which also included an optimal therapeutic proposal. Conclusion: We found that there is a tangible learning curve for urodynamics in terms of several proficiency parameters. A workload of 5 uroflowmetries and 15 cystomanometries with pressure/flow studies may be adequate to complete the learning curve.

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Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder

Cited by 9 publications

References 23 publications

Variability of urodynamic parameters in patients with idiopathic overactive bladder before intradetrusor botulinum toxin injections

Variability of urodynamic parameters in patients with idiopathic overactive bladder before intradetrusor botulinum toxin injections

Perioperative Techniques for the Use of Botulinum Toxin in Overactive Bladder: Results of a Multinational Online Survey of Urogynecologists in Germany, Austria, and Switzerland

The Learning Curve of Urodynamics for the Evaluation of Lower Urinary Tract Symptoms

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