(Poster 157) Time to Repeat Intradetrusor Onabotulinum Toxin-A for Neurogenic Bladder

Objectives: Intradetrusor botulinum toxin is a well studied treatment for neurogenic bladder (NGB). However, the current body of NGB literature lacks outcome data from underrepresented racial and ethnic groups. Thus, the aim of this study was to analyze time to repeat intradetrusor onabotulinum toxin-A (BoNT-A) injection for NGB in a racially diverse urban population.

Methods: All patients with NGB who underwent intradetrusor injections of BoNT-A between 2019 and 2023 were included in a retrospective study. Race and ethnicity were self-reported. Patients received 200 U or 300 U injection regimens per provider/patient preference. Clinical success was defined as any patient-reported subjective improvement 6 weeks after treatment. Treatment discontinuation was defined as failure to repeat an injection within 1 year. Comparisons were made using Fisher exact test and Chi2 test as appropriate for nominal variables, and Mann-Whitney test for continuous variables. Multinomial logistic regression was used to adjust for potential confounders of treatment discontinuation among different racial and ethnic groups.

Results: Seventy-one patients met inclusion criteria. There were no differences in age, gender, body mass index (BMI), parity, insurance, language, prior therapy and NGB etiology between 200 or 300 U regimens. The 300 U group had a greater interval to second injection (12.8 ± 8.0 vs 7.2 ± 3.2 months, p=0.006), mean interval between injections (12.2 ± 7.5 vs 7.0 ± 2.7 months, p=0.007), and clinical success (77.4% vs 46.2%, p=0.002) without any difference in complication (p=0.17). Regarding race and ethnicity, controlling for age, gender, BMI, language, insurance, and botulinum toxin dose, Hispanic patients were 15.4 times more at risk for discontinuation than White patients (p=0.016). Black patients were 11.6 times more at risk for discontinuation than White patients (p=0.024). Controlling for the same confounders, there was no difference in clinical success between ethnic groups (p=0.45).

Conclusions: Intradetrusor BoNT-A 300 U was associated with statistically longer intervals to second injection, average interval to next injection, and greater clinical success in a racially diverse population of NGB patients. However, when controlling for multiple clinical correlates, Hispanic and Black patients were at greater risk for BoNT-A discontinuation compared to White patients despite no difference in subjective improvement among ethnic groups.