Impact of Chronic Pelvic Pain on Bladder BTX-A Outcomes for Overactive Bladder

Objectives: To determine if bladder chemodenervation with onabotulinumtoxinA (BTX-A) is more efficacious for women with refractory overactive bladder (OAB) with concurrent chronic pelvic pain (CPP) than for those without CPP.

Methods: This was an IRB-approved retrospective cohort study of women patients in an academic urogynecology practice who underwent index bladder chemodenervation with 100 units BTX-A from 10/17/2017 to 12/31/2022. Potential patients were identified by Current Procedural Terminology code 52287. Charts were reviewed manually for inclusion eligibility. Patients were included if an OAB-related International Classification of Diseases (ICD)-10 code was listed as procedural indication (Table 1). Patients were classified as having CPP based on presence of relevant ICD-10 code(s) within prior 12 months. Patients were excluded if they had any neurologic condition predisposing to chronic catheterization. Other exclusion criteria were concomitant procedures performed, taking long-term daily antibiotics, prior sacral neurostimulation (SNS), or pre-procedure self-catheterization or indwelling catheter. Baseline characteristics and outcomes within 12 months post-procedure were manually abstracted. Baseline characteristics were compared between groups (CPP vs no CPP) and logistic regression were applied to investigate differences in repeat BTX-A injection within 12 months, adverse events within 30 days, and initiation/re-initiation of other OAB therapy within 12 months between the two groups after adjusting for age. Analyses were conducted using SAS 9.4 with predetermined significance of P < .05.

Results: Fifty-five patients underwent index chemodenervation during the study period, 14 with CPP and 41 without CPP. Most were taking at least 1 OAB medication at the time of procedure (Table 1). There was no difference between groups in proportion who underwent repeat BTX-A injection within 12 months (P=.963). Similarly, there was no difference between groups in UTI treatment (P=.708), need for starting self-catheterization (P=.579), or starting/re-starting OAB medication (P=.327). There was also no difference between groups for those who underwent >1 repeat BTX-A injection or SNS within 12 months (Table 2).

Conclusions: Among women with idiopathic OAB undergoing index bladder chemodenervation with 100 units BTX-A, there was no difference in proportion who underwent repeat injection within 12 months among those with and without CPP. UTI and initiation of self-catheterization also did not differ by presence of CPP. Findings suggest women with and without CPP can be counseled similarly regarding potential benefits and risks of BTX-A for OAB symptoms. A larger sample assessing outcomes with validated questionnaire is needed to confirm these findings.