Efficacy and Safety of OnabotulinumtoxinA for Idiopathic Overactive Bladder: A Double-Blind, Placebo Controlled, Randomized, Dose Ranging Trial

Dmochowski, Roger R.; Chapple, Christopher R.; Νitti, Victor W.; Chancellor, Michael B.; Everaert, Karel; Thompson, Catherine; Daniell, Grace; Zhou, Jihao; Haag‐Molkenteller, Cornelia

doi:10.1016/j.juro.2010.08.021

Cited by 337 publications

(342 citation statements)

References 24 publications

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“…Unfortunately, in this study the amount of 200 U of onabotulinumtoxinA was twice as high as the registered and reimbursed dose for idiopathic OAB and not the standard of care for this third-line therapy. This alternative dose of 200 U was used off label before the compound was registered for idiopathic OAB, but this is not clinical practice at present due to higher chance of adverse events like urinary retention and urinary tract infection [34]. The registered dose of onabotulinumtoxinA for idiopathic OAB is 100 U, which was significantly more effective than placebo at 4 months [35].…”

Section: Oab With or Without Urinary Incontinencementioning

confidence: 99%

Sacral Neuromodulation for the Treatment of Urinary Bladder Dysfunction: Mechanism of Action and Future Directions

Blok

2017

Bioelectron. Med.

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Symptoms of overactive bladder affect a large portion of the world population, especially the elderly. Sacral neuromodulation (SNM) is an effective third-line therapy in patients with overactive bladder. The working mechanism of SNM can be explained by the neural connections of the lower urinary tract. It is proposed that SNM does not work directly on the central components of the micturition reflex, but on cortical and subcortical areas, which in turn inhibits the micturition reflex components in the caudal brainstem. The clinical use and outcomes of SNM are described for several forms of bladder dysfunction. Furthermore, some recent new developments in SNM are discussed, such as expanded indications, more effective use of existing nonrechargeable neuromodulators and the introduction of a rechargeable device. Conservative treatment of overactive bladder (OAB) with or without urinary incontinence consists of pelvic floor exercises, medication and lifestyle intervention, including fluid restriction and timely voiding. If these conservative interventions fail, it is possible to offer electrical stimulation therapies, such as sacral neuromodulation (SNM). In patients suffering from urinary urgency, frequency and urgency incontinence, electrical stimulation of the sacral nerve significantly reduces urinary symptoms and improves patient quality of life. SNM is also used effectively for other forms of bladder dysfunction, such as underactive bladder and bladder pain syndrome (BPS). The increased use of minimally invasive SNM has decreased the need for more open surgical procedures such as ileocystoplasty and urinary diversion. SNM uses an implanted electrode to the third or fourth sacral spinal nerve to deliver a nonpainful electrical stimulus. The brain of the patient perceives this stimulus and, in turn, effectively restores bladder function and alleviates the patients' symptoms. Due to the system-oriented, and not organ-oriented, approach, SNM not only treats urinary disorders, but may also have a beneficial effect on bowel and sexual dysfunction as well as on pelvic pain. Normal control of the lower urinary tractIn order to understand the role of the brain in the control of the urinary bladder and its sphincter, one can make a distinction between structures and axonal tracts in the caudal brainstem and spinal cord, which are intrinsic part of the micturition and continence reflex, and structures and pathways, located in the forebrain and mesencephalon, which modulate these micturition and continence areas. Most of the clinical therapies aimed at functional bladder disorders are not specifically targeted to the micturition reflex areas, but influence cortical and subcortical brain areas, which, in turn, modulate the micturition reflex components. Examples of such therapies are pelvic floor physiotherapy, biofeedback, transcutaneous electrical nerve stimulation, posterior tibial nerve stimulation and SNM. Currently, there is no effective behavioral, chemical or electrical treatment which works directly and specifica...

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Section: Oab With or Without Urinary Incontinencementioning

confidence: 99%

Sacral Neuromodulation for the Treatment of Urinary Bladder Dysfunction: Mechanism of Action and Future Directions

Blok

2017

Bioelectron. Med.

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“…With this dose the response rate (in the reports usually defined as >50% improvement or 'improved' or 'greatly improved' on Treatment Benefit Scales) is in excess of 60% in most studies (range 37-70%), typically with a 20-50% reduction in incontinence episodes (i.e. about 3 fewer leaks per 24 hours), 23-55% of patients achieving continence, and statistically significant improvement in quality of life measures [2][3][4][6][7][8] (Table 3). The response rate in our study is somewhat lower at 43% at one month and 36% at three months, and while there was statistically significant reduction in incontinence episodes (p=0.01) and leakage (p=0.025), the numbers are lower than those reported after cystoscopic injection.…”

Section: Comparison With Cystoscopic Injectionmentioning

confidence: 99%

“…2-3 fewer leaks per 24 hours), 23-55% of patients achieving continence, and a statistically significant improvement in quality of life measures [2][3][4][6][7][8] . The main complications are a 5-36% risk of UTI [2][3][4][5][6]9] and a 4-11% risk of impaired bladder emptying requiring catheterization [1,3,4,6,9] . Some patients also experience postoperative pain and dysuria.…”

Section: Introductionmentioning

confidence: 97%

Intravesical Electromotive Botulinum Toxin in Women with Overactive Bladder – A Pilot Study

2017

ARC Journal of Gynecology and Obstetrics

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“…20 Large randomised trials have shown efficacy in men and women with OAB with or without detrusor overactivity (DO), as well as those with neurogenic DO. 21,22 A good response appears achievable in approximately 85 per cent of patients. The treatment is typically performed as an outpatient procedure under local anaesthetic.…”

Section: Botulinum Toxin-amentioning

confidence: 99%

Overactive bladder in men: treatment options

Birch

Dowson

Seth

et al. 2012

Trends Urol & Men's Health

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Efficacy and Safety of OnabotulinumtoxinA for Idiopathic Overactive Bladder: A Double-Blind, Placebo Controlled, Randomized, Dose Ranging Trial

Cited by 337 publications

References 24 publications

Sacral Neuromodulation for the Treatment of Urinary Bladder Dysfunction: Mechanism of Action and Future Directions

Sacral Neuromodulation for the Treatment of Urinary Bladder Dysfunction: Mechanism of Action and Future Directions

Intravesical Electromotive Botulinum Toxin in Women with Overactive Bladder – A Pilot Study

Overactive bladder in men: treatment options

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