Chen Yu-Chen, Tian Jing-Hui, Kuo Hann-Chorng
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
World J Urol. 2025 Sep 18;43(1):562. doi: 10.1007/s00345-025-05888-8.
To identify predictors of treatment success after urethral botulinum toxin A (100 U) injection in women with video-urodynamic study (VUDS)-diagnosed non-neurogenic dysfunctional voiding (DV), and to develop a nomogram for individualized clinical prediction.
We retrospectively reviewed 398 women with VUDS-confirmed non-neurogenic DV treated with urethral botulinum toxin A at a tertiary center. Baseline demographics and urodynamic variables were compared between responders (Global Response Assessment [GRA] ≥ 2 at 3 months) and non-responders (GRA < 2). Predictive modeling used multivariate logistic regression with stepwise selection. The entire cohort was randomly split into a training set (70%) for model development and a test set (30%) for internal validation. Model discrimination was evaluated by area under the receiver operating characteristic curve (AUC), and a nomogram was constructed from independent predictors.
At 3-month follow-up, 186 patients (46.7%) were classified as responders. Responders had significantly fewer prior Botox injections, lower bladder sensation thresholds, higher detrusor pressure at Qmax (Pdet), higher maximum flow rate (Qmax), greater voided volume, lower cystometric bladder capacity, higher voiding efficiency, and lower post-void residual (PVR). Multivariate analysis identified older age (OR: 1.025), higher Pdet (OR: 1.029), and lower PVR (OR: 0.989) as independent predictors of success. The model showed excellent discrimination in training (AUC = 0.847) and test (AUC = 0.871) sets. A nomogram was developed for individualized risk estimation.
Older age, higher Pdet, and lower PVR independently predict successful response to urethral botulinum toxin A in women with non-neurogenic DV. This nomogram may guide personalized counseling and treatment decisions.
确定在视频尿动力学检查（VUDS）诊断为非神经源性功能性排尿障碍（DV）的女性中，尿道注射A型肉毒杆菌毒素（100 U）后治疗成功的预测因素，并制定用于个体化临床预测的列线图。
我们回顾性分析了在一家三级中心接受尿道A型肉毒杆菌毒素治疗的398例经VUDS确诊为非神经源性DV的女性。比较了反应者（3个月时全球反应评估[GRA]≥2）和无反应者（GRA<2）的基线人口统计学和尿动力学变量。预测模型采用逐步选择的多变量逻辑回归。将整个队列随机分为用于模型开发的训练集（70%）和用于内部验证的测试集（30%）。通过受试者操作特征曲线下面积（AUC）评估模型的辨别力，并根据独立预测因素构建列线图。
在3个月的随访中，186例患者（46.7%）被归类为反应者。反应者先前接受肉毒杆菌毒素注射的次数明显较少，膀胱感觉阈值较低，Qmax时逼尿肌压力（Pdet）较高，最大尿流率（Qmax）较高，排尿量较大，膀胱容量测量值较低，排尿效率较高，残余尿量（PVR）较低。多变量分析确定年龄较大（OR：1.025）、Pdet较高（OR：1.029）和PVR较低（OR：0.989）是成功的独立预测因素。该模型在训练集（AUC=0.847）和测试集（AUC=0.871）中显示出优异的辨别力。制定了用于个体化风险评估的列线图。
年龄较大、Pdet较高和PVR较低可独立预测非神经源性DV女性对尿道A型肉毒杆菌毒素治疗的成功反应。该列线图可指导个性化咨询和治疗决策。
