Risk Factors for Infection Following Third-line Therapy for Overactive Bladder

Autor: Felicia Lane, Karen L. Noblett
Rok vydání: 2017
Předmět:
Zdroj: Current Bladder Dysfunction Reports. 12:268-272
ISSN: 1931-7220
1931-7212
DOI: 10.1007/s11884-017-0433-4
Popis: Sacral neuromodulation and intradetrusor onabotulinum toxinA are FDA approved treatment options for overactive bladder (OAB) and considered third-line therapies according to the American Urological Association (AUA) guidelines. Although each therapy has unique associated risks, infection is a common adverse event shared by both. The purpose of this review is to identify risk factors for infection in third-line therapies for OAB. A PUBMED® and MEDLINE® search was performed for scientific publications on “sacral neuromodulation,” “sacral nerve stimulation,” “onabotulinum toxinA,” “Botox,” “percutaneous tibial nerve stimulation (PTNS)” and “infection,” and “overactive bladder (OAB)” between the years 2003 and 2016. Articles were screened for reports on adverse events and were included in the review if they contained information on infection. We also limited this review to idiopathic OAB in adults. A total of 127 articles were identified (61 in the onabotulinum toxinA and 64 in the sacral neuromodulation (SNM) groups, respectively, and two containing combined data). No articles referencing PTNS and infection were identified; thus, PTNS is not reviewed in this manuscript. Twenty-nine articles met criteria and served as the source information for this article. The primary infection associated with sacral neuromodulation is device-related and ranges between 1.7 and 7.8% in patients implanted for OAB. The most common infection in the onabotulinum toxinA group is a urinary tract infection, with rates ranging from 9.5 to 44%, with the vast majority classified as uncomplicated. Potential risk factors for surgical site infection associated with SNM include patients who are immunocompromised, those with diabetes, or those with a higher BMI. Potential risk factors for urinary tract infection (UTI) associated with onabotulinum toxinA include active medication vs. placebo, urinary retention, and the use of clean intermittent catheterization. Onabotulinum toxinA and SNM are safe and effective third-line therapies for refractory OAB. Onabotulinum toxinA injection is associated with UTIs, and risk factors appear to be the use of active drug vs. placebo, urinary retention, and use of clean intermittent catheterization. In contrast, SNM is associated primarily with surgical site infection. Risk factors identified include diabetes, higher BMI, or immunocompromised status.
Databáze: OpenAIRE
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