What Is the Role of Additional Pharmacotherapy and Neuromodulation in Patients with Marginal Benefit from Botulinum Toxin Injection?

Abstract

There are no randomized control trials examining the role of concurrent medical therapy and BTX-A; rather, there are observational studies in the neurogenic population. Furthermore, there are two observational studies on the role of SNM in BTX-A refractory idiopathic OAB patients demonstrating its safety and efficacy. There are many options available to the patient who fails BTX-A. Further research in this specific patient population is necessary to determine why patients have suboptimal responses and to delineate the next step in treatment.

Outcomes of Intradetrusor Onabotulinum Toxin A Therapy in Overactive Bladder Refractory to Sacral Neuromodulation

“…First-line therapy for OAB includes behavioral modifications such as fluid restriction, dietary management, and timed voiding [7]. If behavioral modifications fail to control symptoms, second-line measures include pelvic floor physical therapy and oral anticholinergics and beta-3 agonists [7,8]. These therapies may fail due to poor compliance with pelvic floor physical therapy or side effects associated with medical therapy [9].…”