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

  • Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

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.

Recent Findings

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.

Summary

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.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine Education Building, University of California, 900 University Avenue, Riverside, CA, 92521, USA

    Karen L. Noblett

  2. Department of OB/GYN, University of California, Irvine, 101 City Drive, Orange, CA, 92868, USA

    Felicia Lane

Authors
  1. Karen L. Noblett
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  2. Felicia Lane
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Correspondence to Karen L. Noblett.

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Conflict of Interest

Dr. Noblett reports personal fees from Medtronic, grants and personal fees from Allergan, outside the submitted work

Dr. Lane has no conflicts of interests to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Reconstructed Bladder Function and Dysfunction

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Noblett, K.L., Lane, F. Risk Factors for Infection Following Third-line Therapy for Overactive Bladder. Curr Bladder Dysfunct Rep 12, 268–272 (2017). https://doi.org/10.1007/s11884-017-0433-4

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  • DOI: https://doi.org/10.1007/s11884-017-0433-4

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