Trigonal-Sparing vs. Trigonal-Involved OnabotulinumtoxinA Injection for the Treatment of Overactive Bladder: A Systematic Review and Meta-Analysis

Abstract

Objective: Overactive bladder (OAB) is a disease characterized by the presence of urinary urgency. We carried out a meta-analysis to assess the effectiveness and safety of trigonal-involved injection of onabotulinumtoxinA (BoNT-A) in comparison with the trigonal-sparing technique in cases with OAB [neurogenic detrusor overactivity (NDO) and idiopathic detrusor overactivity (IDO)].Methods: Randomized controlled trials (RCTs) of BoNT-A injection for OAB were searched systematically by using EMBASE, MEDLINE, and the Cochrane Controlled Trials Register. The datum was calculated by RevMan version 5.3.0. The original references of relating articles were also reviewed.Results: In total, six RCTs involving 437 patients were included in our analysis. For OAB, the trigone-including group showed a different patient symptom score (p = 0.03), complete dryness rate (p = 0.002), frequency of incontinence episodes (p = 0.01), detrusor pressure at maximum flow rate (p = 0.01), and volume at the first desire to void (p = 0.0004) compared with the trigone-sparing group. Also, a trigone-including intradetrusor injection demonstrated a significant improvement in the patient symptom score (p = 0.0004), complete dryness rate (p = 0.0002), frequency of incontinence episodes (p = 0.0003), detrusor pressure at maximum flow rate (p = 0.01), and volume at the first desire to void (p = 0.00006) compared with the trigone-sparing group for treatment of NDO. The adverse events rates were similar in both groups.Conclusions: The meta-analysis has demonstrated that trigone-including BoNT-A injection was more effective compared with the trigone-sparing injection for the treatment of OAB, especially for NDO.

Anatomical location and number of injection sites of intravesical OnabotulinumtoxinA for females with refractory idiopathic overactive bladder: A scoping review

“…Three high-quality meta-analyses assert that trigone injection is not only safe but potentially more effective than trigone-sparing technique. 6,8,9 As outlined in the results we note that many of the studies are of small sample size and are lacking in consistent follow-up or methodology regarding efficacy and adverse effects.…”

“…Cui et al's 9 meta‐analysis evaluated the effectiveness and safety of BTN/A injections for iOAB and nOAB. The analysis included six trials with total 437 patients and showed that injections including the trigone were more effective than trigone‐sparing injections in improving symptoms, achieving dryness, reducing frequency of incontinence, decreasing detrusor pressure, and increasing voiding volume.…”

“…These were published between 2005 and 2021 and were from seven countries: Taiwan, the United Kingdom, the United States, South Korea, Spain, China, and Canada. There were three systematic review articles, all these focused on the inclusion or exclusion of the trigone 6,8,9 . A further four prospective randomized controlled trials (RCTs) investigated the inclusion or exclusion of the trigone 10–13 .…”

“…There were three systematic review articles, all these focused on the inclusion or exclusion of the trigone. 6,8,9 A further four prospective randomized controlled trials (RCTs) investigated the inclusion or exclusion of the trigone. [10][11][12][13] Three prospective studies explored the number of injection sites.…”

Urinary Tract Infection in Overactive Bladder: An Update on Pathophysiological Mechanisms

“…The large proportion of patients refractory to pharmacotherapy also supports an alternative pathophysiology to detrusor overactivity seen in OAB. Indeed, the relative success of neurotoxins that inhibit sensory nerve activity, such as resiniferatoxin and BOTOX ( Guo et al, 2013 ; Hsieh et al, 2016 ; Cui et al, 2021 ), in relieving OAB symptoms refractory to pharmacotherapy suggests increased sensory outflow is responsible for the symptoms of urgency and urinary frequency. However, BOTOX treatment is invasive, has been associated with frequent side effects, and requires repeated doses at approximately 6 months intervals ( Schurch et al, 2005 ; Apostolidis et al, 2009 ; Chen and Kuo, 2020 ) indicating the treatment is masking, rather than treating the underlying cause of bladder sensory neuron hypersensitivity.…”