Comparison of different types of therapy for overactive bladder: A systematic review and network meta-analysis

Abstract

To compare the efficacy and safety of different interventions [including antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS)] for treating idiopathic overactive bladder (OAB). PubMed, Embase, Cochrane Library, and other sources were searched for randomized controlled trials (RCTs) comparing interventions for overactive bladder from 1 January 2000 to 19 April 2021. A systematic review and network meta-analysis were performed by two authors independently. Fifty-five RCTs involving 32,507 patients were included in this analysis. Overall, antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation, and peripheral tibial nerve stimulation were more efficacious than placebo, and sacral neuromodulation showed the best effect for reducing micturition frequency, urgency episodes and urgency urinary incontinence episodes. OnabotulinumtoxinA was the best intervention for achieving reductions of 100 and ≥50% in the number of urinary incontinence episodes/day, and peripheral tibial nerve stimulation was the best intervention for reducing urinary incontinence episodes. Antimuscarinics, mirabegron and peripheral tibial nerve stimulation had a similar efficacy for reducing micturition frequency, urinary incontinence episodes and urgency urinary incontinence episodes. The results revealed that all interventions examined herein were efficacious for managing adult overactive bladder syndrome compared with placebo. Furthermore, sacral neuromodulation and OnabotulinumtoxinA were the most efficient treatments for overactive bladder.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251966], identifier [CRD42021251966].

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A

“…In recent decades, BoNT-A has been widely applied in the treatment of skeletal or smooth muscle hypertonicity and modulation of chronic inflammation, and sensory and glandular dysfunction [ 54 55 ]. BoNT-A has been recommended as the treatment for idiopathic OAB and neurogenic DO due to spinal cord injury or multiple sclerosis after the medical treatment with an adequate dose of antimuscarinics and mirabegron has been failed [ 56 57 58 59 60 ]. Detrusor injections of BoNT-A for OAB refractory to the oral medication have been proven highly effective than the other lines of therapy and are the most effective option among all pharmacologic therapies [ 57 ].…”

“…BoNT-A has been recommended as the treatment for idiopathic OAB and neurogenic DO due to spinal cord injury or multiple sclerosis after the medical treatment with an adequate dose of antimuscarinics and mirabegron has been failed [ 56 57 58 59 60 ]. Detrusor injections of BoNT-A for OAB refractory to the oral medication have been proven highly effective than the other lines of therapy and are the most effective option among all pharmacologic therapies [ 57 ]. BoNT-A detrusor injections can not only significantly improve OAB symptoms and quality of life, but also the urodynamic parameters [ 58 ].…”

Lax Uterosacral Ligament and Urge Urinary Incontinence: MRI Findings in Symptomatic Patients Versus Healthy Volunteers

“…The management of UUI includes pharmacological treatments [ 3 ] and minimally invasive interventions such as posterior tibial nerve stimulation and Botox injections [ 4 , 5 ]. However, the cure rates for the latter two treatments have been reported to be "unsatisfactory," not exceeding 30–40%, with short-term effects that necessitate repeated treatments [ 4 , 5 ]. In rare cases, surgical interventions, such as bladder augmentation or urinary diversions, may be required for refractory UUI cases [ 4 – 6 ].…”