Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Abstract

Introduction Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT‐A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT‐A injection after the failure of SNM for iOAB. Methods We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT‐A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. Results Seventy‐six patients (62 female) were included. The percentage of success of first BoNT‐A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3‐day bladder diary. Twenty‐eight patients (36.8%) were put under clean intermittent self‐catheterization transitory. After a mean follow‐up of 57.7 (±38.5) months, median number of injections was 2 (1‐15). Overall, 42 patients (55.2%) stopped injections during follow‐up. The estimated 36‐months discontinuation‐free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). Conclusion BoNT‐A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long‐term discontinuation rate.

Sacral neuromodulation in patients with refractory overactive bladder symptoms after failed Botulinum toxin therapy: Results in a large cohort of patients

“…The difference in the location of action between BoNT‐A and SNM also suggests that previous treatment with BoNT‐A, should not affect the success rate of subsequent treatment with SNM, and vice versa. In literature, the recent study by Baron et al 17 confirms BoNT‐A can be used in SNM non‐responders, although a higher BoNT‐A discontinuation rate was reported at long‐term follow‐up. Trinh et al 18 also concludes BoNT‐A after failed SNM remains an option but showed lower success rate compared to patients without prior SNM.…”

Refractory overactive bladder patients who chose sacral neuromodulation therapy after failed OnabotulinumtoxinA treatment: A systematic review and meta-analysis

“…Kirkpatrick et al [20] performed a retrospective analysis and found that when patients with urge incontinence OAB received BTX therapy after failure of SNM therapy, it was even more effective than was BTX therapy. By contrast, recent studies reported that the success rate when OAB patients chose BTX therapy after the initial choice and ineffectiveness of SNM therapy was only 27%-39% [21,22]. Currently, there is a need for more high-quality research before one can confirm the efficacy of OAB in those who receive BTX therapy after the failure of initially undergoing SNM therapy.…”

Development of a flowchart reflecting the current attitude and approach towards idiopathic overactive bladder treatment in Belgium: A Delphi study

“…Likewise, further recommendations on treatments after the failure of SNM or BTX are lacking. We acknowledge this is a missed opportunity since literature on this topic is scarce 19,20 . On other topics, such as the choice between AC and β3A, the maximum number of drugs that should be tried in monotherapy before proceeding to combination therapy, and the role of PTNS, there was also no consensus.…”