Meta-Analysis of Randomized Controlled Trials Using Botulinum Toxin A at Different Dosages for Urinary Incontinence in Patients With Overactive Bladder

Abstract

Background: Urinary incontinence (UI) is a common and refractory complication for patients with neurogenic detrusor overactivity (NDO) or idiopathic overactive bladder (IOAB). Objectives: To evaluate the effect of Botulinum toxin A (BTX-A) based on different dosages strategy for UI. Method: The MEDLINE, Ovid EMbase, The Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Internet (CNKI), and WanFang database were searched for relevant published randomized controlled trials (RCTs) between 1969 to September 31, 2018. All database were searched to identify relevant randomized controlled trials (RCTs) that investigated the clinical benefit of BTX-A for management of UI in patients with NDO and IOAB. Results: This meta-analysis involved 19 original studies. The BTX-A was superior to placebo in reducing episodes of UI for NDO patients in all subgroups of different dosages for different durations, and also reduced maximum detrusor pressure in all kinds of 200U and 300U at 6 weeks. However, it increased post void residual in different dosages of 200U at 2 weeks. For IOAB patients, compared to placebo, BTX-A increased detrusor compliance for different dosages of 200U and 300U at 12 and 36 weeks, but it increased risk of urinary tract infections at other dosages. Conclusions: This meta-analysis indicated that BTX-A 200U and 300U are more effective than placebo in the treatment of NDO, with minimal, local, and manageable adverse events. Furthermore, BTX-A 300U and 200U could also improve detrusor compliance of IOAB. However, more RCTs would still be necessary to explore the effect of BTX-A on management of UI in NDO and IOAB patients.

Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study

“…Along with Onabotulinum toxin A and PTNS, SNM has been a breakthrough in the treatment of refractory OAB and offers several advantages. A meta-analysis of 19 original studies, found Onabotulinum toxin A to be superior to placebo in reducing the episodes of urinary incontinence in patients with OAB [41]. However, intra-detrusor injection of Onabotulinum toxin A increases the risk of UTI and urinary retention necessitating clean intermittent catheterization (CIC).…”

Recent advances in managing overactive bladder

“…A recent meta-analysis of 19 studies found that doses of 200 U and 300 U were more effective than placebo for the treatment of neurogenic detrusor overactivity, with minimal but manageable side effects 33 . A double-blind, randomised, placebo-controlled trial investigated different doses of botulinum toxin 34 .…”

Time for a botulinum toxin passport?

“…A meta‐analysis of five randomized controlled trials has shown increased generalized muscle weakness following intravesical BOTOX injection when compared with placebo (risk ratio [RR]: 2.59; 95% confidence interval [CI]: 1.36–4.91) 9 . The risk of generalized systemic weakness is likely to be dose related; a separate recent meta‐analysis looking at variable BOTOX doses found that the risk of weakness was increased following BOTOX 300 U (RR: 1.97; 95% CI: 1.24–3.13) but not 200IU (RR: 1.59; 95% CI: 0.97–2.62) when compared with placebo 10 …”