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Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications.

Publication ,  Journal Article
Komesu, YM; Amundsen, CL; Richter, HE; Erickson, SW; Ackenbom, MF; Andy, UU; Sung, VW; Albo, M; Gregory, WT; Paraiso, MF; Wallace, D ...
Published in: Am J Obstet Gynecol
January 2018

BACKGROUND: Women with refractory urgency urinary incontinence (ie, unresponsive to behavioral and pharmacological interventions) are treated with onabotulinumtoxinA or sacral neuromodulation. OBJECTIVE: The objective of the study was to compare treatment efficacy and adverse events in women <65 and ≥65 years old treated with onabotulinumtoxinA or sacral neuromodulation. STUDY DESIGN: This study was a planned secondary analysis of a multicenter, randomized trial that enrolled community-dwelling women with refractory urgency urinary incontinence to onabotulinumtoxinA or sacral neuromodulation treatments. The primary outcome was a change in mean daily urgency urinary incontinence episodes on a bladder diary over 6 months. Secondary outcomes included ≥75% urgency urinary incontinence episode reduction, change in symptom severity/quality of life, treatment satisfaction, and treatment-related adverse events. RESULTS: Both age groups experienced improvement in mean urgency urinary incontinence episodes per day following each treatment. There was no evidence that mean daily urgency urinary incontinence episode reduction differed between age groups for onabotulinumtoxinA (adjusted coefficient, -0.127, 95% confidence interval, -1.233 to 0.979; P = .821) or sacral neuromodulation (adjusted coefficient, -0.698, 95% confidence interval, -1.832 to 0.437; P = .227). Among those treated with onabotulinumtoxinA, women <65 years had 3.3-fold greater odds of ≥75% resolution than women ≥65 years (95% confidence interval, 1.56 -7.02). Women <65 years had a greater reduction in Overactive Bladder Questionnaire Short Form symptom bother scores compared with women ≥65 years by 7.49 points (95% confidence interval, -3.23 to -11.74), regardless of treatment group. There was no difference between quality of life improvement by age. Women ≥65 years had more urinary tract infections following onabotulinumtoxinA and sacral neuromodulation (odds ratio, 1.9, 95% confidence interval, 1.2-3.3). There was no evidence of age differences in sacral neuromodulation revision/removal or catheterization following onabotulinumtoxinA treatment. CONCLUSION: Younger women experienced greater absolute continence, symptom improvement, and fewer urinary tract infections; both older and younger women had beneficial urgency urinary incontinence episode reduction, similar rates of other treatment adverse events, and improved quality of life.

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Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

January 2018

Volume

218

Issue

1

Start / End Page

111.e1 / 111.e9

Location

United States

Related Subject Headings

  • Urinary Tract Infections
  • Urinary Incontinence, Urge
  • Transcutaneous Electric Nerve Stimulation
  • Sacrum
  • Quality of Life
  • Obstetrics & Reproductive Medicine
  • Intervertebral Disc Degeneration
  • Humans
  • Female
  • Botulinum Toxins, Type A
 

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Komesu, Y. M., Amundsen, C. L., Richter, H. E., Erickson, S. W., Ackenbom, M. F., Andy, U. U., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network, . (2018). Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. Am J Obstet Gynecol, 218(1), 111.e1-111.e9. https://doi.org/10.1016/j.ajog.2017.10.006
Komesu, Yuko M., Cindy L. Amundsen, Holly E. Richter, Stephen W. Erickson, Mary F. Ackenbom, Uduak U. Andy, Vivian W. Sung, et al. “Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications.Am J Obstet Gynecol 218, no. 1 (January 2018): 111.e1-111.e9. https://doi.org/10.1016/j.ajog.2017.10.006.
Komesu YM, Amundsen CL, Richter HE, Erickson SW, Ackenbom MF, Andy UU, et al. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. Am J Obstet Gynecol. 2018 Jan;218(1):111.e1-111.e9.
Komesu, Yuko M., et al. “Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications.Am J Obstet Gynecol, vol. 218, no. 1, Jan. 2018, pp. 111.e1-111.e9. Pubmed, doi:10.1016/j.ajog.2017.10.006.
Komesu YM, Amundsen CL, Richter HE, Erickson SW, Ackenbom MF, Andy UU, Sung VW, Albo M, Gregory WT, Paraiso MF, Wallace D, Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. Am J Obstet Gynecol. 2018 Jan;218(1):111.e1-111.e9.
Journal cover image

Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

January 2018

Volume

218

Issue

1

Start / End Page

111.e1 / 111.e9

Location

United States

Related Subject Headings

  • Urinary Tract Infections
  • Urinary Incontinence, Urge
  • Transcutaneous Electric Nerve Stimulation
  • Sacrum
  • Quality of Life
  • Obstetrics & Reproductive Medicine
  • Intervertebral Disc Degeneration
  • Humans
  • Female
  • Botulinum Toxins, Type A