Komesu Yuko M, Amundsen Cindy L, Richter Holly E, Erickson Stephen W, Ackenbom Mary F, Andy Uduak U, Sung Vivian W, Albo Michael, Gregory W Thomas, Paraiso Marie Fidela, Wallace Dennis
University of New Mexico Health Sciences Center, Albuquerque, NM.
Duke University, Durham, NC.
Am J Obstet Gynecol. 2018 Jan;218(1):111.e1-111.e9. doi: 10.1016/j.ajog.2017.10.006. Epub 2017 Oct 12.
Women with refractory urgency urinary incontinence (ie, unresponsive to behavioral and pharmacological interventions) are treated with onabotulinumtoxinA or sacral neuromodulation.
The objective of the study was to compare treatment efficacy and adverse events in women <65 and ≥65 years old treated with onabotulinumtoxinA or sacral neuromodulation.
This study was a planned secondary analysis of a multicenter, randomized trial that enrolled community-dwelling women with refractory urgency urinary incontinence to onabotulinumtoxinA or sacral neuromodulation treatments. The primary outcome was a change in mean daily urgency urinary incontinence episodes on a bladder diary over 6 months. Secondary outcomes included ≥75% urgency urinary incontinence episode reduction, change in symptom severity/quality of life, treatment satisfaction, and treatment-related adverse events.
Both age groups experienced improvement in mean urgency urinary incontinence episodes per day following each treatment. There was no evidence that mean daily urgency urinary incontinence episode reduction differed between age groups for onabotulinumtoxinA (adjusted coefficient, -0.127, 95% confidence interval, -1.233 to 0.979; P = .821) or sacral neuromodulation (adjusted coefficient, -0.698, 95% confidence interval, -1.832 to 0.437; P = .227). Among those treated with onabotulinumtoxinA, women <65 years had 3.3-fold greater odds of ≥75% resolution than women ≥65 years (95% confidence interval, 1.56 -7.02). Women <65 years had a greater reduction in Overactive Bladder Questionnaire Short Form symptom bother scores compared with women ≥65 years by 7.49 points (95% confidence interval, -3.23 to -11.74), regardless of treatment group. There was no difference between quality of life improvement by age. Women ≥65 years had more urinary tract infections following onabotulinumtoxinA and sacral neuromodulation (odds ratio, 1.9, 95% confidence interval, 1.2-3.3). There was no evidence of age differences in sacral neuromodulation revision/removal or catheterization following onabotulinumtoxinA treatment.
Younger women experienced greater absolute continence, symptom improvement, and fewer urinary tract infections; both older and younger women had beneficial urgency urinary incontinence episode reduction, similar rates of other treatment adverse events, and improved quality of life.
难治性急迫性尿失禁（即对行为和药物干预无反应）的女性采用A型肉毒毒素或骶神经调节治疗。
本研究的目的是比较接受A型肉毒毒素或骶神经调节治疗的65岁以下和65岁及以上女性的治疗效果和不良事件。
本研究是一项多中心随机试验的计划二次分析，该试验纳入了社区居住的难治性急迫性尿失禁女性，进行A型肉毒毒素或骶神经调节治疗。主要结局是膀胱日记中6个月内平均每日急迫性尿失禁发作次数的变化。次要结局包括急迫性尿失禁发作次数减少≥75%、症状严重程度/生活质量的变化、治疗满意度以及与治疗相关的不良事件。
两个年龄组在每次治疗后每日平均急迫性尿失禁发作次数均有所改善。没有证据表明，对于A型肉毒毒素治疗（调整系数，-0.127，95%置信区间，-1.233至0.979；P = 0.821）或骶神经调节治疗（调整系数，-0.698，95%置信区间，-1.832至0.437；P = 0.227），年龄组之间每日平均急迫性尿失禁发作次数的减少存在差异。在接受A型肉毒毒素治疗的患者中，65岁以下女性急迫性尿失禁发作次数减少≥75%的几率是65岁及以上女性的3.3倍（95%置信区间，1.56 - 7.02）。无论治疗组如何，65岁以下女性与65岁及以上女性相比，膀胱过度活动症问卷简表症状困扰评分降低幅度更大，为7.49分（95%置信区间，-3.23至-11.74）。年龄对生活质量改善的影响无差异。65岁及以上女性在接受A型肉毒毒素和骶神经调节治疗后发生尿路感染的情况更多（优势比，1.9，95%置信区间，1.2 - 3.3）。没有证据表明在接受A型肉毒毒素治疗后，骶神经调节修复/移除或导尿方面存在年龄差异。
年轻女性实现了更高的绝对控尿率、症状改善且尿路感染更少；老年女性和年轻女性在急迫性尿失禁发作次数减少方面均有益处，其他治疗不良事件发生率相似，生活质量均得到改善。
