Anticholinergic Therapy vs. OnabotulinumtoxinA for Urgency Urinary Incontinence

Abstract

BACKGROUND Anticholinergic medications and onabotulinumtoxinA are used to treat urgency urinary incontinence, but data directly comparing the two types of therapy are needed. METHODS We performed a double-blind, double-placebo–controlled, randomized trial involving women with idiopathic urgency urinary incontinence who had five or more episodes of urgency urinary incontinence per 3-day period, as recorded in a diary. For a 6-month period, participants were randomly assigned to daily oral anticholinergic medication (solifenacin, 5 mg initially, with possible escalation to 10 mg and, if necessary, subsequent switch to trospium XR, 60 mg) plus one intradetrusor injection of saline or one intradetrusor injection of 100 U of onabotulinumtoxinA plus daily oral placebo. The primary outcome was the reduction from baseline in mean episodes of urgency urinary incontinence per day over the 6-month period, as recorded in 3-day diaries submitted monthly. Secondary outcomes included complete resolution of urgency urinary incontinence, quality of life, use of catheters, and adverse events. RESULTS Of 249 women who underwent randomization, 247 were treated, and 241 had data available for the primary outcome analyses. The mean reduction in episodes of urgency urinary incontinence per day over the course of 6 months, from a baseline average of 5.0 per day, was 3.4 in the anticholinergic group and 3.3 in the onabotulinumtoxinA group (P = 0.81). Complete resolution of urgency urinary incontinence was reported by 13% and 27% of the women, respectively (P = 0.003). Quality of life improved in both groups, without significant between-group differences. The anticholinergic group had a higher rate of dry mouth (46% vs. 31%, P = 0.02) but lower rates of catheter use at 2 months (0% vs. 5%, P = 0.01) and urinary tract infections (13% vs. 33%, P<0.001). CONCLUSIONS Oral anticholinergic therapy and onabotulinumtoxinA by injection were associated with similar reductions in the frequency of daily episodes of urgency urinary incontinence. The group receiving onabotulinumtoxinA was less likely to have dry mouth and more likely to have complete resolution of urgency urinary incontinence but had higher rates of transient urinary retention and urinary tract infections. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women’s Health; ClinicalTrials.gov number, NCT01166438.)

Long-term use of solifenacin in pediatric patients with overactive bladder: Extension of a prospective open-label study

“…This can be explained by the fact that neurogenic bladders are often more refractory to medical therapies, as pointed out by Horstmann and colleagues. 22 A 94% success rate in the non-neurogenic group is therefore reassuring since other treatments, such as intravesical oxybutynin, sacral neuromodulation or botulinum toxin (with their inherent 5% to 11% risk of clean intermittent catheterization), 23,24 would be deferred. For non-responders or children responding only partially to therapy, initial urodynamics were less favourable (stronger uninhibited detrusor contractions and smaller bladder capacity).…”

Urinary Bacteria in Adult Women With Urgency Urinary Incontinence

“…The full methods of the ABC trial and its primary results have been published elsewhere [7,8]. Clinical sites are supported by a data coordinating center, an NIH Project Scientist, and an external Steering Committee Chair.…”

Onabotulinumtoxina Intravesical Treatment in Patients Affected by Overactive Bladder Syndrome: Best Practice in Real-Life Management

“…This has been due to the positive results obtained in multiple randomized trials with the use of Onabot/A in idiopathic OAB patients, which has definitely confirmed the high efficacy and tolerability of this kind of minimally invasive treatment (7)(8)(9). Nevertheless, to date, we still need to establish what is the best Onabot/A treatment's protocol for patients affected by idiopathic OAB, and what is the more appropriate care of patient before, during and after treatment.…”