From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance.
Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
Urogynecology (Phila). 2023 May 1;29(5):511-519. doi: 10.1097/SPV.0000000000001297. Epub 2022 Nov 21.
The objective was to determine whether patients with diabetes mellitus (DM) treated with intravesical onabotulinumtoxinA (BoNT) injection for overactive bladder (OAB) had increased urinary retention requiring clean intermittent catheterization (CIC), as well as the impact of disease duration and severity. We hypothesize that patients with DM will have higher rates of retention after BoNT injection.
We performed a retrospective cohort analysis of women in the Kaiser Permanente Southern California Health System who underwent BoNT injection for OAB, excluding women with a history of urinary retention or neurogenic bladder.
We identified 565 patients, 410 in the control group and 155 in the DM group. No significant difference was found in the rate of CIC (9% in the control group versus 5.8% in the DM group, P = 0.2), voiding dysfunction, and peak postprocedure postvoid residual volume (PVR). Patients with diabetes had a significantly increased rate of postprocedure urinary tract infection (UTI; 27.6% versus 38.1%, P = 0.02). Urinary tract infection was significantly associated with urinary retention (adjusted odds ratio [OR], 2.26; 95% confidence interval [CI], 1.02-4.99; P = 0.045) and peak PVR ≥200 mL (adjusted OR, 2.42; 95% CI, 1.15-5.06; P = 0.019). Diabetic disease duration and severity were not a predictor of urinary retention, elevated PVR, or voiding dysfunction; however, the presence of ≥1 disease-related complication was a predictor of UTI (adjusted OR, 2.81; 95% CI, 1.34-5.91; P = 0.006).
Diabetic patients had a similar rate of urinary retention requiring CIC after BoNT injection for OAB compared with nondiabetic patients. Diabetic patients had an increased risk of UTI based on disease severity.
本研究旨在确定接受膀胱内注射肉毒毒素 A（BoNT）治疗膀胱过度活动症（OAB）的糖尿病（DM）患者发生需要清洁间歇性导尿（CIC）的尿潴留的发生率，以及疾病持续时间和严重程度的影响。我们假设 DM 患者在 BoNT 注射后会有更高的潴留率。
我们对 Kaiser Permanente Southern California Health System 接受 BoNT 治疗 OAB 的女性患者进行了回顾性队列分析，排除了有尿潴留或神经源性膀胱病史的患者。
我们共确定了 565 名患者，其中对照组 410 名，DM 组 155 名。两组 CIC 率（对照组 9%，DM 组 5.8%，P = 0.2）、排尿功能障碍和术后最大剩余尿量（PVR）无显著差异。DM 组术后尿路感染（UTI）发生率明显升高（27.6% vs. 38.1%，P = 0.02）。UTI 与尿潴留显著相关（校正优势比[OR]，2.26；95%置信区间[CI]，1.02-4.99；P = 0.045），与最大 PVR ≥200 mL 显著相关（校正 OR，2.42；95% CI，1.15-5.06；P = 0.019）。DM 疾病持续时间和严重程度不是尿潴留、PVR 升高或排尿功能障碍的预测因素；然而，≥1 种疾病相关并发症是 UTI 的预测因素（校正 OR，2.81；95% CI，1.34-5.91；P = 0.006）。
与非糖尿病患者相比，接受 BoNT 治疗 OAB 的糖尿病患者发生需要 CIC 的尿潴留的比率相似。根据疾病严重程度，糖尿病患者发生 UTI 的风险增加。
