Botox Use in the Older Woman: An Advanced Bladder Treatment Option

• Published in: Current geriatrics reports 2023-06, Vol.12 (2), p.28-39
• Main Authors: Cooper, Anne C., Gerjevic, Kristen A.
• Format: Article
• Language: English
• Subjects: Age; Aging; Algorithms; Bladder; Botulinum toxin; Costs; Dementia; Diabetes; Disease; Frailty; Geriatrics; Geriatrics/Gerontology; Medicine; Medicine & Public Health; Mobility; Neurology; Pain Medicine; Patients; Pelvis; Primary care; Psychopharmacology; Review; Rheumatology; Spinal stenosis; Topical Collection on Female Geriatric Urology; Urinary incontinence; Urine; Urogenital system; Womens health
• ISSN: 2196-7865; 2196-7865
• DOI: 10.1007/s13670-023-00384-6

Purpose of Review This article focuses on challenges of caring for older women with urgency urinary incontinence (UUI), and asks how treatment algorithms for UUI could be tailored to the needs of older women. Recent Findings Urgency urinary incontinence is highly prevalent among older women, and has significant health, social and economic impact for patients, caregivers and society. It is more difficult to treat among older women in part due to interaction with other geriatric syndromes and comorbidities. Also, the existing treatment algorithm, including anticholinergic medications as a mainstay of therapy, is less relevant to older patients due to increased risks and limitations of all therapies. Use of onabotulinumtoxinA treatment may have a more favorable risk/benefit profile compared with other therapies, and merits consideration earlier in the treatment of older women with UUI. Summary Urgency urinary incontinence is more difficult to treat among older women, and an updated treatment algorithm is needed to meet existing and increasing need. Use of first-line therapies and beta agonists should be supported among primary care providers to accelerate access to care. Subspecialty providers should give earlier consideration of bladder onabotulintumtoxinA (BOTOX©) treatment prior to or instead of oral medications, in part because of its lower systemic side effects, favorable cost profile, and versatility of dosing. Other third line therapies remain applicable as well but have more fixed disadvantages among older patients. Research is needed to scrutinize the outcomes, side effects, and experience of BTX treatment among older women, and more broadly, to query the influence of factors such as frailty, comorbidities, dementia and polypharmacy on response to treatment of UUI.