OnabotA outcomes for elderly, younger patients compared

OnabotulinumtoxinA (onabotA [Botox]) injections are safe to treat overactive bladder in patients 80 years of age and older, researchers say.

Urinary tract infections are no more common in this population than in younger people, according to Patricia M. Zahner, MD, of Cleveland Clinic. She presented the study at the AUA annual meeting in San Francisco.

"We treat a lot of elderly patients with Botox and it's effective," she told Urology Times.

OnabotA injections are common third-line treatments for overactive bladder. But some providers may be afraid to use them in elderly patients because of the most common adverse events: urinary retention and urinary tract infections.

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"We worry that they may get more sick," said Dr. Zahner, who worked on the study with Howard B. Goldman, MD, and colleagues.

To examine the risks of this treatment in older patients, the authors retrospectively reviewed the records of a series of patients who underwent onabotA injections for overactive bladder from 2007 to 2017.

They compared 62 patients with a mean age of 84 years, ranging from 80-94 years, to 68 patients with a mean age of 59 years, ranging from 50-70 years.

There was no significant difference in comorbidities between the two cohorts (65% in the younger cohort and 76% in the elderly cohort, p=.24), or in reported satisfaction (p=.31).

Significantly more of the younger patients (53%) had neurologic conditions than the older patients (29%), p=.006.

Next:UTIs, rate of catheterization, hematuria in elderly vs. younger patientsThe overall rate of complications for the younger patients was 16% versus 23% for the older patients, but this difference did not reach statistical significance (p=.36).

The rate of urinary tract infections among the younger patients was 7.6% versus 6.5% among the elderly cohort. This difference was not statistically significant (p=.84).

The rate of catheterization was 4.4% among the younger patients. None of these patients had an underlying neurologic condition. Two patients had 100 units. One had 200 units. All three were women with a history of prior incontinence surgery.

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Among the older patients, 11% had catheterization, but the difference between the younger and older cohorts in this complication was also not statistically significant (p=.14).

Two of the seven older patients with urinary retention had neurologic conditions. Five had 100 units. Two had 200 units. Three were men and four were women.

"Some octogenarians might not be willing to catheterize, so there are pros and cons," said Dr. Zahner.

Hematuria affected 4.4% of the younger patients and 1.6% of the older ones (p=.36). There were 10 unscheduled phone calls for the younger patients and 17 for the older patients (p=.22).

Unscheduled office visits and re-hospitalization rates were both more common in the older patients, but not significantly so. Pain was reported by 5.1% of the younger patients and none of the older patients, but this was also not statistically significant (p=.73).

Regardless of age, those with the most severe comorbidities were the most likely to be re-hospitalized (odds ratio 16.1, [p=.03]).