Predictive Urodynamic Parameters for The Treatment Efficacy of Onabotulinum Toxin A in Neurogenic Lower Urinary Tract Dysfunction.

Purpose: To evaluate urodynamic parameters that may serve as predictors of treatment efficacy with Onabotulinumtoxin-A (onaBoNT-A) in patients with neurogenic lower urinary tract dysfunction (NLUTD).

Materials and methods: Patients with NLUTD who received 200 IU onaBont-A injections were included in the study. Urodynamic parameters and the correlations between these parameters and treatment outcomes were analyzed. The primary endpoints were changes in the daily pad usage, and the secondary endpoint was to demonstrate the relationship between duration of treatment efficacy of onabotulinumtoxin-A with preoperative urodynamic parameters in patients with NLUTD.

Results: The data of 74 patients were analyzed retrospectively, and 66 (89%) patients benefited from onaBoNT-A treatment. A negative correlation was observed between the number of pads changed per day and maximum cystometric capacity (MCC) (p = 0.024, r = -0.277). A positive correlation existed between the duration of treatment efficacy of onaBoNT-A and change in detrusor pressure during filling cystometry (ΔPdet) (p = 0.018, r = 0.291), whereas a negative correlation was noted with bladder compliance (p = 0.035, r = -0.260). Any additional indicator of its urodynamic efficacy showing a correlation with the number of pads changed per day has not been identified yet.

Conclusion: OnaBoNT-A injections effectively manage NLUTD, with MCC being a potential predictor of treatment response. Other urodynamic parameters showed limited predictive value. Patients with lower MCC experienced greater improvements in reducing the number of pads used following treatment. High ΔPdet and low bladder compliance were associated with treatment benefits persisting for longer periods of time.