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International Urogynecology Journal

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01-05-2020 | Overactive Bladder | Original Article

Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation

Authors: Caroline G. Elmer-Lyon, Judy A. Streit, Elizabeth B. Takacs, Patrick P. Ten Eyck, Catherine S. Bradley

Published in: International Urogynecology Journal | Issue 5/2020

Abstract

Introduction and hypothesis

Intradetrusor onabotulinumtoxinA (BTX) and sacral neuromodulation (SNM) are effective treatments for refractory urgency urinary incontinence/overactive bladder (UUI/OAB). BTX carries a risk of urinary tract infection (UTI), which is concerning for the development of multidrug resistant (MDR) UTI. We hypothesized that BTX might carry a higher risk of UTI and MDR UTI compared with SNM and that UTI and MDR UTI risk might increase after repeat BTX injection.

Methods

This retrospective cohort study included women undergoing BTX or SNM for refractory UUI/OAB in 2012–2016. UTI and MDR UTI were assessed up to 1 year post-treatment or until repeat treatment and compared between initial BTX and SNM and between repeat BTX injections. Univariate analyses included Chi-squared and Fisher’s exact tests and generalized linear models (GLM) with logit link function. Multivariate analyses used GLM to assess the best predictor variables for any UTI.

Results

One hundred and one patients were included (28 BTX, 73 SNM). Rates of UTI (39.3% [95% CI 21.5, 59.4] BTX vs 37.0% [95% CI 26.0, 49.1] SNM) were similar in the two groups at all time intervals. One MDR UTI occurred after SNM. Risk of UTI did not increase with repeat BTX (11 out of 28 [39.3%], 6 out of 17 [35.3%], and 4 out of 7 [57.1%] after 1, 2, and ≥ 3 treatments respectively; p = 0.62). Multivariate analysis found that history of recurrent UTI (OR 2.5, 95%CI 0.98–6.39) and prolapse repair (OR 4.6, 95%CI 1.23–17.07) had increased odds of UTI.

Conclusions

Rates of UTI were similar in patients undergoing BTX and SNM. MDR UTI was rare. Patients with prior prolapse repair or recurrent UTI may be at a higher risk of UTI after either procedure.

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Title: Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation
Authors: Caroline G. Elmer-Lyon
Judy A. Streit
Elizabeth B. Takacs
Patrick P. Ten Eyck
Catherine S. Bradley
Publication date: 01-05-2020
Publisher: Springer International Publishing
Keywords: Overactive Bladder
Urinary Incontinence
Nerve Stimulation
Urinary Tract Infection
Urinary Incontinence
Published in: International Urogynecology Journal / Issue 5/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04007-7

At a glance: The STEP trials

Springer Medicine

Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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