Correlation between the nerve growth factor levels and OAB.-V8 questionnaire forms. in patients underwent antimuscarinic treatment and onabotulinum toxin-A injection

CORRELATION BETWEEN THE NERVE GROWTH FACTOR LEVELS AND OAB.-V8 QUESTIONNAIRE FORMS. IN PATIENTS UNDERWENT ANTIMUSCARINIC TREATMENT AND ONABOTULINUM TOXIN-A INJECTION Dr.Süleyman SAĞIR Expertise Thesis, Department of Urology Thesis Supervisor: Doç. Dr. Ömer BAYRAK August 2020, 80Pages Aim: To compare the levels of nevre growth factor (NGF) in urine samples before, and after treatment of overactive bladder (OAB) in patients who received antimuscarinic treatment, and underwent onabotulinumtoxin-A (onaBoNT-A) injection. Inaddition, we purposed to show whether NGF levels were correlated with overactive bladder questionnaire [ 8-item overactive bladder questionnaire (OAB-V8)], urogenital distress inventory [Urinary Distress Inventory, Short Form (UDI-6)] and quality of life questionnaire [Incontinence Impact Questionnaire, Short Form(IIQ-7)]. Material and method: Following the approval of the local ethics committee (2016/313, 28.11.2016), 40 patients referred to our department between August 2017, and May 2019 with OAB symptoms were evaluated prospectively. Inthestudy, solifenacin 5 mg was prescribed in 20 naive patients(group 1), and onaBoNT-A injection was performed to 20 patients (group 2) who refractory to antimuscarinics. Urine samples were taken from all patients before treatment, and after 3rd and 6th months of the treatment, and NGF levels were measured. Symptom scores of OAB-V8, UDI-6, and IIQ-7 were also recorded before the treatment, and 3rd and 6th months of follow-up. The relevance of the data for normal distribution was evaluated with the Shaphiro Wilk Test. The Mann Whitney U Test was used to compare the variables that were not normally distributed in independent groups. Freidmanand Dunn multiple comparison tests were used for analyses at differenttimes. The relationships between numerical variables were tested with Spearman correlation coefficient. Results:Meanagewasfound 39.1±12.22years in group 1,and 48.26±17.94years in group 2 (p=0.073).Therewasnosignificantdifferencebetweenthegroups in terms of initial OAB-V8, IIQ-7 and UDI-6 scores.Whereas NGF valuesshowednosignificantdifferenceover time in theonaBoNT-Ainjectiongroup(p=0.069, p=0.069); NGF levelsweresignificantlylower at 3rdand 6th months in patients receiving antimuscarinic therapy compared to preoperative period (p=0.003, p=0.007). At 3rdmonth, a significant correlation observed in terms of NGF and OAB-V8 (r=0.704, p=0.001), IIQ-7 (r=0.676, p=0.001) and UDI-6 (r=0.583, p=0.007) scores in the antimuscarinic group (Figure 1). Inaddition, there was also a strong correlation between NGF level, and OAB-V8 (r=0.811, p=0.004), and IIQ-7 (r=0.671, p=0.001) scores in the antimuscarinic group at 6th month follow-up. However, there was no significant correlation between NGF levels and other variables in the onaBoNT-A injection group at 3rdand 6th months follow-up. Conclusion: In recent year ,studies biomarkers have been increasing to provide treatment monitoring in OAB. In our study, there was no significant chance in NGF values in the group of patients who received OnaBoNT-A injection in time, whereas in the groupof patients who were given antimuscarinic therapy, it was found to be significantly lower at 3rd and 6th months compared to before treatment. At the same time, due to the urine NGF levels correlate with symptom scores in the antimuscarinic treatment group, it suggests that it is a good marker to evaluate the effectiveness of treatment in OAB patients receiving antimuscarinic therapy. The reason for the difference in the mechanism of action may be considered to be the reason for lack of this correlation in onaBoNT-A injection group. Keywords: Antimuscarinic, Onabotulinumtoxin A, Nevre Growth Factor, Questionnaire Forms