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Optimizing onabotA for OAB: What are some common misconceptions?
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“Like any disease state, you want to make sure you have the right diagnosis; otherwise, you're not going to have a successful treatment plan," says Karyn S. Eilber, MD.
The landscape of treatment for overactive bladder (OAB) encompasses several lines of therapeutic options, one of which is onbotulinumtoxinA (onabotA, Botox). In a recent interview with Urology Times®, Karyn S. Eilber, MD, explained the importance of confirming the diagnosis of OAB before outlining treatment options.
“Like any disease state, you want to make sure you have the right diagnosis; otherwise, you're not going to have a successful treatment plan. Especially [in] patients who have mixed urinary incontinence, if they're predominantly stress incontinence, and you start with something like Botox, they might not really realize the benefit of it, because you're not addressing their predominant symptom per se. It’s always important to have the diagnosis, because otherwise you're setting yourself up for failure,” said Eilber, chair of Cedars-Sinai Medical Group department of surgery and professor of urology, and associate professor of obstetrics & gynecology at Cedars-Sinai Medical Center in Los Angeles, California.
During the interview, Eilber also addressed misconceptions surrounding the use of onabotA for OAB. One such misconception, she said, is that “you have to absolutely follow the injection paradigm that was outlined in the clinical trials.”
“I started doing Botox in the early 2000s, before it had an indication [for OAB], and some of our very first patients were in the pediatric population, and [those patients were] injected in 10 sites. So that's what I started doing, and it worked for me for many years. Even when the clinical trials came out, I still stayed with my old paradigm. For a lot of people, especially if you want to do [this] in the office, if you do 20 injections, that can be technically difficult if you're doing a flexible cystoscopy. It can also be quite uncomfortable if the patient doesn't have uniform anesthesia, with local anesthesia in their bladder,” Eilber said.
Another misconception is that patients must have a urinalysis done before each procedure.
Patients, Eilber said, “forget that the Botox wears off. They think they have a UTI [urinary tract infection] because they have increasing frequency and urgency, when, in fact, they don't. It's just time for their Botox again. They come in, they leave their urine, cancel their appointment, [the urinalysis comes back] normal, they get rescheduled. So it becomes this logistically difficult thing.”
