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No. 049. Impact of Anxiety Traits & Coping Styles on Treatment Outcome In Drug-Refractory, Idiopathic Overactive Bladder Patients Managed by Intravesical Botulinum Toxin A (BTXA). Olivia Ruskin , Lewis Chan, Chasta Bacsu , Vincent Tse , Jessica Medd

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No. 049

Impact of Anxiety Traits &Coping Styles on

Treatment Outcome In Drug-Refractory,

Idiopathic Overactive Bladder Patients Managed by

IntravesicalBotulinum Toxin A (BTXA)

Olivia Ruskin , Lewis Chan, ChastaBacsu, Vincent Tse, Jessica Medd

Department of Urology, Concord Repatriation General Hospital, University of Sydney, Australia


Overactive bladder syndrome (OAB) affects around 17% of the population worldwide with incontinence occurring in approximately 1/3 of patients.1

OAB negatively affects life physically, psychologically, and socially 2. Treatments range from behavioural modifications and anticholinergics, to more invasive techniques such as intravesical injections of Botulinum Toxin A (BTXA) and sacral neuromodulation.

This study investigates the anxiety traits and coping styles in drug-refractory OAB patients who have received BTXA injections.


50 patients were sent questionnaires with 25 patients responded (60% females and 40% males). The mean age was 66 years ( range 34 to 93 ). The mean age for males was 64.9 years and for females was 66.8 years.

RESULTS 1 - Females had higher mean scores for anxiety and all coping styles compared with males.

Compared to the STAI normative data, males in our study produced lower scores in both S and T-anxiety (by 3.52 and 1.39 respectively), and females scored higher in both anxiety styles (by 7.33 and 10.28 respectively). Females also adopts more coping styles than males (p<0.05)

RESULTS 2 - When the total S-anxiety and total T-anxiety mean scores are compared between responders ( complete or partial ) to non-responders, the non-responders have a higher T-anxiety score which trends towards statistical significance (p = 0.061). No significance was achieved for the S-anxiety scores (p=0.134). ( Figures 1 and 2 )

RESULTS 3 – Emotion-focussed coping is the style most subjects used, regardless of degree of BTXA response. ( p=0.30 ) ( Figure 3 )


To investigate whether drug-refractory OAB patients who have poorer responses to BTXA therapy (based on clinical and subjective measures), have higher anxiety levels and poorer coping skills.

To determine whether these traits affect responses to BTXA. We hypothesize that patients with poorer responses to BTXA will have higher anxiety scores and altered coping style profiles compared to those patients with good responses.

Figure 1 – Total Trait Anxiety Scores between BTXA Responders and Non-responders ( p = 0.061, Kruskal Wallis test )


The Sydney Southwest Area Health Service (SSWAHS) Human Research Ethics Committee approved the study.


Included – All subjects with drug refractory non-neurogenic OAB who attended the urology clinic. They had all received at least one intravesical injection of BTXA. Drug-refractory is defined as persistent OAB-wet despite at least one anticholinergic agent.

Excluded – Subjects who went on to have sling surgery were excluded. Those who had a poor grasp of English and required interpreters in clinical settings were also excluded.


Two validated questionnaires – the 40-item State Trait Anxiety Inventory (STAI) and the 29-item BriefCOPE Questionnaire (BCQ) 3,4 – were mailed to patients.

The STAI succinctly differentiates between the temporary state anxiety (S-anxiety) and the more general and long-standing trait anxiety (T-anxiety). It contains 20 items.

The BCQ questionnaire has 2 items representing each of the 14 conceptually different coping reactions, making up 28 items in total. It is designed as a quick tool for researchers to assess important coping responses.


Single centre retrospective cohort study.

Each patient was assigned a clinical “BTXA respondent score” by their urologist : 1 = good response; 2 = some response and 3 =poor response. Researcher was blinded to this score until after the STAI and BCQ data were entered into an Excel spreadsheet. Urologists were blinded to the patients’ questionnaire scores. 

Figure 2 – Total State Anxiety Scores between BTXA Responders and Non-responders ( p = 0.134, Kruskal Wallis test )

Figure 3 : Males’ and females’ coping scores


Subjects with no response to BTXA have higher trait anxiety scores than patients with better BTXA responses, with results trending towards significance (p = 0.061).

It is unclear whether higher trait anxiety causes a poorer response, or vice versa.

Females report higher anxiety levels than males and may be better at identifying the coping styles they use to manage their condition.

This is the first study to show that in idiopathic OAB, there may be psychological ( ie. extra-vesical) factors which may influence clinical response to BTXA treatment.


1. Abrams P, C.L., Fall M, et al: , The standardization of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology, 2003. 61: p. 37-49.

2. Tubaro, A., Defining Overactive Bladder: Epidemiology and Burden of Disease. Urology, 2004. 64(suppl 6A): p. 2-6.

3. Spielberger, C., State-Trait Anxiety Inventory: Scoring Manual, R.L. Gorsuch, RE., Editor. 1970, State University of Florida: Tallahassee, Florida.

4. Carver, C., Brief COPE Questionnaire. 1997, University of Miami, Florida: Miami, Florida. p. 1.

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