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We sought to identify clinical and demographic characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation therapies.We analyzed data from the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation versus BoTulinum Toxin Assessment) trial. Baseline participant characteristics and clinical variables were associated with 2 definitions of treatment response, including 1) a reduction in mean daily urgency incontinence episodes during 6 months and 2) a 50% or greater decrease in urgency incontinence episodes across 6 months. The OAB-S (Overactive Bladder-Satisfaction) questionnaire was used to assess satisfaction.A greater reduction in mean daily urgency incontinence episodes was associated with higher HUI-3 (Health Utility Index-3) scores in the onabotulinumtoxinA group and higher baseline incontinence episodes (each p0.001) in the 2 groups. Increased age was associated with a lesser decrease in incontinence episodes in the 2 groups (p0.001). Increasing body mass index (adjusted OR 0.82/5 points, 95% CI 0.70-0.96) was associated with reduced achievement of a 50% or greater decrease in incontinence episodes after each treatment. Greater age (adjusted OR 0.44/10 years, 95% CI 0.30-0.65) and a higher functional comorbidity index (adjusted OR 0.84/1 point, 95% CI 0.71-0.99) were associated with reduced achievement of a 50% or greater decrease in urgency incontinence episodes in the onabotulinumtoxinA group only (p0.001 and 0.041, respectively). In the onabotulinumtoxinA group increased satisfaction was noted with higher HUI-3 score (p = 0.002) but there was less satisfaction with higher age (p = 0.001).Older women with multiple comorbidities, and decreased functional and health related quality of life had decreased treatment response and satisfaction with onabotulinumtoxinA compared to sacral neuromodulation for refractory urgency incontinence.

A recent Cochrane review found that women with stress urinary incontinence (SUI) were less likely to leak on objective testing following the mid-urethral tension-free vaginal tape (TVT) procedure than after the laparoscopic Burch colposuspension operation. Subjective cure rates were similar, however, and postoperative follow-up was limited to 18 months. The present prospective randomized trial, carried out at an academic tertiary referral center, followed 72 women with urodynamic SUI who were randomly assigned to have the Burch operation or TVT procedure for a median of 65 months. Nearly three-fourths of the women were followed for 4 to 8 years. Patients completed the Incontinence Severity Index, Urogenital Distress Inventory, Incontinence Impact Questionnaire, and Patient Global Impression of Improvement scales. Somewhat more women having laparoscopic surgery (57% vs. 48%) reported any degree of urinary incontinence 4 to 8 years after surgery, for a relative risk of 1.19 (95% confidence interval, 0.71-2.0); the difference was not significant. Only 11% of women in the Burch group and 8% of those in the TVT group reported having bothersome incontinence after surgery. The group difference in rates of moderate to severe incontinence 4 to 8 years after surgery was not statistically significant. More than 65% of women in both groups reported being better or very much better than before surgery. Only 7% and 4%, respectively, felt that they were much worse or very much worse. In all, 4% of women were reoperated on for SUI. Comparable numbers of patients in the 2 groups were using pads or taking anticholinergic medication. Quality of life had improved significantly in both groups within 1 to 2 years after surgery, and this continued throughout follow-up. The investigators believe that the TVT procedure is about as effective as the laparoscopic Burch colposuspension operation in women with SUI. Although a substantial number of women has some degree of incontinence 4 to 8 years postoperatively, this is not bothersome to a majority of those affected.