LUTS

Question 1

OAB ROSETTA trial

Answer 1

ROSETTA Trial – BOTOX One-Pager

Overview
Randomized trial comparing BOTOX (200U) vs Sacral Neuromodulation (SNM) in refractory
overactive bladder (OAB).

Effectiveness
• Greater reduction in urgency urinary incontinence (UUI) at 6 months vs SNM • Similar outcomes
at 24 months (~3 fewer episodes/day)

Symptom Improvement
• ↓ urgency, frequency, nocturia • ~50% achieved ≥75% reduction in UUI

Patient Satisfaction
• Higher early satisfaction vs SNM

Adverse Effects
• UTI: ~24–35% (higher than SNM) • Intermittent catheterization: ~6–20%
Durability
• Temporary effect • ~72% required repeat injection within 2 years

Cost
• More cost-effective than SNM

Clinical Takeaway
• Effective 3rd-line therapy • Better short-term efficacy • Trade-off: UTIs + retention risk • Requires
repeat dosing

Question 2

SENIOR study

Answer 2

SENIOR Study –
Overview
Study evaluating cognitive safety of oxybutynin in elderly patients with overactive bladder (OAB).
Population
• Age ≥65 years • Diagnosed with OAB
Key Finding: Cognition
• Oxybutynin (IR) causes significant cognitive impairment • Affects memory, attention, reaction time
• Worst cognitive profile among antimuscarinics
Mechanism
• Highly lipophilic • Crosses blood–brain barrier → central anticholinergic effects
Clinical Risks
• Delirium • Cognitive decline • Increased fall risk
Comparison
• Newer agents (solifenacin, darifenacin): - More bladder selective - Less CNS penetration - Better
cognitive safety
Clinical Takeaway
• Avoid oxybutynin (especially IR) in elderly • Prefer newer antimuscarinics or β3 agonists
(mirabegron)
Memory Tip
“OXY = OLD brain gets foggy