73: Impact of refractory urgency urinary incontinence treatment on bowel and sexual function

Women with refractory urgency urinary incontinence (UUI) can be treated with onabotulinumtoxinA (BTX) or sacral neuromodulation (SNM). The goal of this study was to compare the impact of these treatments on bowel and sexual function. This was a planned supplemental analysis of a randomized trial in women with refractory UUI treated with BTX (n=190) or SNM (n=174). Bowel and sexual symptoms were measured at baseline, 6, 12, and 24 months. Bowel symptoms were measured using the St Mark’s (Vaizey) Fecal Incontinence severity scale. Sexual symptoms were measured using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) and the Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). The PISQ-IR allows calculation of 6 subscores for sexually active women (SA-AO: Arousal, Orgasm; SA-PR: Partner Related; SA-CS: Condition Specific; SA-GQR: Global Quality Rating; SA-CI: Condition Impact; SA-D: Desire) and 4 subscores for those not sexually active (NSA-PR; NSA-CS; NSA-GQR; and NSA-CI). Primary outcome was change in Vaizey and PISQ-12 scores between baseline and 6 months. Secondary outcomes were change in PISQ-IR scores between baseline and 6 months and change in Vaizey, PISQ-12 and PISQ-IR scores between baseline and 12 and 24 months. Intent to treat analysis was performed using repeated measures mixed model to estimate change in all parameters from baseline while adjusting for the baseline score. A subgroup analysis of women with clinically significant bowel symptoms was conducted based on baseline Vaizey score of ≥12. There were no differences between BTX and SNM groups in baseline Vaizey (7.6+5.3 v 6.6+4.9, p=0.07), PISQ-12 (33.4+7.5 v 32.7+6.7, p=0.55), or PISQ-IR subscores. 39% in BTX and 45% in SNM group were sexually active at baseline (p=0.25). There was no difference between women treated with BTX and SNM at 6 months in improvement in Vaizey score (-1.9, 95% CI -2.6 to -1.2 v -0.9, 95% CI -1.7 to -0.2, p=0.07) or PISQ-12 score (2.2, 95% CI 0.7 to 3.7 v 2.2, 95% CI 0.7 to 3.7, p=0.99). There was no difference in improvement between groups in the PISQ-IR subscores at 6 months, or the Vaizey, PISQ-12, and PISQ-IR subscores at 12 and 24 months. In a subgroup (BTX=33 and SNM=22) with baseline Vaizey score ≥12, there was a clinically important improvement in bowel symptoms in both groups from baseline to 6 months with no difference in improvement between the BTX and SNM groups (-5.1, 95% CI -7.3 to -2.8 v -5.6, 95% CI -8.5 to -2.6, p=0.8). There were no differences in improvement of bowel and sexual symptoms in women with UUI treated with BTX or SNM. Women with clinically significant bowel symptoms at baseline had improvement in symptoms although there was no difference between the treatments. Our findings may not pertain to a fecal incontinence or sexual dysfunction treatment-seeking group.