Effectiveness of BTX-A and neuromodulation in treating OAB with or without detrusor overactivity: a systematic review

Abstract

The limited evidence suggests that urodynamic diagnosis of DO does not alter patient reported outcomes for invasive treatments such as BTX-A and SNS. Noninferiority RCTs powered to evaluate the role of DO in predicting treatment response are required.

Posterior tibial nerve stimulation for overactive bladder—techniques and efficacy

“…Overactive bladder (OAB) is defined by the International Continence Society as 'urinary urgency, with or without frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology' [1]. Treatment recommendations from various scientific bodies include behavioural therapy and oral medications with antimuscarinics, beta 3 adrenoreceptors or intravesical botulinum toxin A injections [2][3][4]. In patients who do not respond to these therapies the use of tibial nerve stimulation has been recommended with various grades of evidence [5].…”

Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease

“…28 Several studies have evidenced that the presence of DO is strongly associated with urgency incontinence. 29 Hence, although not supported by current evidence, 30 some authors hypothesize that BoNT-A might be better tailored to "OAB wet"/motor urgency (ie, DO-driven), while SNM might be more appropriate for "OAB dry"/sensory urgency (ie, without DO on urodynamics). All the patients in our series had both DO and urgency incontinence at baseline which could explain the satisfactory outcomes obtained in the light of the aforementioned assumption.…”

Transcutaneous posterior tibial nerve stimulation: Ready for prime time?

“…By including only patients with detrusor overactivity (DO) Ramirez-Garcia and colleagues may have lowered the amplitude of treatments effect as some series have suggest that PTNS may be more effective in OAB patients without DO. 8 Further studies examining the role of percutaneous and transcutaneous PTNS in other OAB subpopulations (elderly, supraspinal/"brain" OAB, patients without DO, etc . .…”

“…One may assume that, rather than being competitors, percutaneous and transcutaneous PTNS may each be well suited for different OAB populations. By including only patients with detrusor overactivity (DO) Ramirez‐Garcia and colleagues may have lowered the amplitude of treatments effect as some series have suggest that PTNS may be more effective in OAB patients without DO . Further studies examining the role of percutaneous and transcutaneous PTNS in other OAB subpopulations (elderly, supraspinal/“brain” OAB, patients without DO, etc …) will be needed to better determine optimal indications of each PTNS option.…”