Julia Neuenschwander

Study Design: Retrospective cohort study in consecutive patients. Objective: To evaluate the long‐term effectiveness of and treatment adherence to intradetrusor onabotulinumtoxin A (BoNT‐ONA) injections in patients with neurogenic detrusor overactivity (NDO). Methods: Consecutive patients with NDO who had undergone intradetrusor BoNT‐ONA treatment at a single tertiary neuro‐urology referral center were identified from a registry documenting off‐label use of BoNT‐ONA prior to formal regulatory approval. Demographic, clinical, and urodynamic data obtained before and after each treatment were collected. In patients performing intermittent catheterization, treatment success was defined by the following urodynamic criteria: bladder capacity ≥ 400 mL, bladder compliance ≥20 mL/cmH ₂ O, and maximum detrusor storage pressure 2 O. In patients with an indwelling catheter, treatment success was defined as the achievement of urinary continence. In addition, data regarding treatment discontinuation and the underlying reasons were collected. Descriptive statistical analyses were performed to evaluate treatment effectiveness, adherence, and discontinuation patterns. Results: The data of 142 patients (51 females) with a mean age of 35.9 ± 13.1 years and a mean NDO duration of 6.4 ± 8.1 years at the beginning of the BoNT‐ONA treatment were analyzed. Over a mean follow‐up period of 12.0 ± 6.1 years, evaluated patients received a mean 7.9 ± 5.5 treatments. The BoNT‐ONA treatment was continued in 34 (23.9%) patients. In 95 (66.9%) patients, the treatment was discontinued, and 13 (9.2%) patients were lost to follow‐up. Five of the 34 patients (14.7%) who continued BoNT‐ONA treatment received additional oral medication for NDO. Two (5.9%) and three (8.8%) patients showed reduced bladder compliance and increased detrusor storage pressure, respectively. Ten (34.5%) patients showed increased cystatin C values during the follow‐up. The main reason for BoNT‐ONA treatment discontinuation was insufficient effectiveness in 56 (58.9%) patients. Most patients who discontinued treatment transitioned to oral medication (45/95, 47.4%) and surgical interventions (25/95, 26.3%). Conclusion: Treatment of NDO with BoNT‐ONA injections into the detrusor demonstrated sustained effectiveness in one quarter of the evaluated patients during a follow‐up period of more than 12 years. The main reason for BoNT‐ONA treatment discontinuation was insufficient effectiveness.

Background/Objectives: The objective of this study is to compare nerve-sparing (NS) and non-nerve-sparing (NNS) robot-assisted radical prostatectomy (RARP) techniques used to treat localized prostate cancer. Numerous studies have evaluated the impact of NS techniques on patient-reported outcomes. However, there are unaddressed methodological issues making interpretation of results difficult. Therefore, we performed a comparison of the two techniques, accounting for methodological threats, including patient selection and confounding. Methods: We sampled 120 patients with similar disease burden who underwent RARP by the same surgeon, either with NS (n = 84) or NNS (n = 36) and assessed changes in lower urinary tract (LUT) function and bother, and bowel function/bother using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire and the six-item International Index of Erectile Function (IIEF-6) survey at 6 weeks and 12 months postoperatively. Multivariable linear regression models were used to adjust for differences in age, preoperative PSA levels, pathological tumor stage and Gleason-score of patients receiving either NS or NNS. Results: At 6 weeks postoperatively, the NNS group had a significantly larger decrease in LUT function compared to the NS group (−17.42; 95% Confidence Interval (CI): −31.31, −3.53; p = 0.0145). At 12 months, both groups recovered substantially, and no group differences were observed (p > 0.9). No significant differences were observed between the NS and NNS groups for the EPIC bowel subscores, whereas the IIEF-6 showed borderline significance at 12 months. Conclusions: The results suggest a small impact of NS vs. NNS RARP on important patient-reported outcomes when controlling for tumor biology, surgeon skill, and patient characteristics. These results need to be confirmed by larger studies using similar sampling strategies and design considerations.