Relationship between onabotulinum toxin A injection efficacy and urodynamic parameters in patients with neurogenic lower urinary tract dysfunction

Neurogenic Lower Urinary Tract Dysfunction, Specialty Thesis in Medicine, Department of Urology, Gaziantep, 2024 Onabotulinum toxin A (onaBoNT-A) application is a treatment option whose effectiveness and safety have been demonstrated in most studies in patients with neurogenic lower urinary tract dysfunction, which requires a multidisciplinary approach in clinical management and is characterized by the association of symptoms based on the neural field location where the pathology occurs. The aim of our study is to investigate the urodynamic parameters that can predict the success of onaBoNT-A injection. Within the scope of our study, 74 patients who received 200 IU onaBoNT-A injection treatment for the first time in our clinic in the last 10 years and met the inclusion criteria; They were examined in terms of laboratory, radiological and urodynamic parameters. Analyzes were made on patient data 6 months after OnaBoNT-A application. Based on patient satisfaction, patients who benefited from 200 IU onaBoNT-A injection treatment and those who did not benefit were divided into two groups. Our research on factors that can predict effectiveness is specific to the benefited subgroup; The correlation between the decrease in the number of pads used daily and the duration of benefit from onaBoNT-A injection and urodynamic parameters was examined by multiple regression analysis. At our primary point of analysis in our study, no urodynamic, laboratory or radiological parameters were monitored that predict effectiveness between the groups that responded to onaBoNT-A treatment and those that did not respond to treatment. At the secondary evaluation point; It was observed that as compliance decreased, the duration of effectiveness of onaBoNT-A was prolonged, as maximum detrusor pressure increased, the duration of benefit was prolonged, and with low cystometric capacity, the decrease in the number of pads used per day was greater (p=0.035, p=0.018, p=0.024, respectively). The effectiveness and safety of onaBoNT-A application in patients with neurogenic lower urinary tract dysfunction (NLUTD) has been demonstrated. It is known that the number of studies on parameters that can predict response to this treatment is limited. As a result of our study, no parameter could be shown that could predict the benefit that could be seen from onaBoNT-A application. However, some urodynamic parameters that correlate with effectiveness have been identified. Low compliance and high detrusor pressure were found to be positively correlated with benefit duration, while low capacity was negatively correlated with the number of pads. Key words: Predictive factor, Onabotulinum Toxin A, Urodynamics