A systematic review and meta-analysis of effectiveness and safety of therapy for overactive bladder using botulinum toxin A at different dosages

Song, Jukun; Zhang, Wenjun; Xie, Jian; Yao, Qing; Zeng, Wenjing; Zhang, Chao; Niu, Yu‐Ming

doi:10.18632/oncotarget.20056

Cited by 16 publications

(22 citation statements)

References 54 publications

(83 reference statements)

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“…Nevertheless, the anticholinergic medicine is increasingly inappropriate for long-term therapy of NDO and IOAB, which is reflected in the unsatisfied effect and potential complications such as vesicoureteral reflux and even renal failure (Majumdar, 2004;Asimakopoulos et al, 2012), and also the high socioeconomic cost is considerable. Therefore, metaanalyses (Cui et al, 2013;Mehta et al, 2013;Cui et al, 2015;Sun et al, 2015;Zhang et al, 2015;Zhou et al, 2015;Cheng et al, 2016;Gu et al, 2017) evaluating the therapeutic effect of botulinum toxin A (BTX-A) on UI in OAB patients have increased as well as the relevant RCTs in recent years, in which the BTX-A demonstrated a satisfied clinical benefit. (Flynn et al, 2004;Kessler et al, 2005;Kuo, 2005;Popat et al, 2005;Rajkumar et al, 2005;Schulte-Baukloh et al, 2005;Schmid et al, 2006) Furthermore, the BTX-A is recommended for management of UI in OAB patient by the American Urological Association (AUA) guidelines (Gormley et al, 2015), and the other interventions consist of education and behavior therapies.…”

Section: Introductionmentioning

confidence: 99%

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

Gong

et al. 2020

Front. Pharmacol.

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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.

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Section: Introductionmentioning

confidence: 99%

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

Gong

et al. 2020

Front. Pharmacol.

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“…Two forms of BTX-A, o n a b o t u l i n u m t o x i n A ( B o t o x ® , A l l e r g a n ) a n d abobotulinumtoxinA (Dysport®, Ibsen), have been evaluated for the treatment of NDO. The outcomes of both are comparable [37,43].…”

Section: Botulinum Toxinmentioning

confidence: 89%

“…Efficacy of BTX injections in the detrusor and an increase in MCC with a decrease of MDP has been noted by other authors in 32 to 100% of patients [32••, 33-35, 37-39, 53-57, 58•]. In some papers, detrusor reflex volume (DRV), volume at which the first detrusor contraction occurred, was measured [37,39]. According to Schulte-Baukloh, in the follow-up cystometry, mean reflex volume changed from 97.1 ml before injection to 178.6 ml after 4 weeks [35].…”

Section: Effects Of Btx Detrusor Injectionmentioning

confidence: 96%

“…In the majority of studies, 20-30 consecutive sites of bladder dome were injected each with a small portion of the solution [32••, 33-35, 37, 38••, 39, 53-57, 58•]. Some authors postulated only ten injection sites are necessary while others concluded that up to 50 consecutive injections are needed [37,59].…”

Section: Cystoscopic Proceduresmentioning

confidence: 99%

“…In the literature, some parameters from cystometric evaluation were measured and compared. First, most authors noted an increase in maximal cystometric capacity (MCC) with a decrease of maximum detrusor pressure (MDP) [37]. In a study by Neel, MCC increased significantly from 96 to 163 ml, and the MDP decreased significantly from 76 to 50 cm H2O [69].…”

Section: Effects Of Btx Detrusor Injectionmentioning

confidence: 99%

See 2 more Smart Citations

The Current Role of Botox in a Pediatric Neurogenic Bladder Condition

Kroll

2019

Curr Bladder Dysfunct Rep

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Purpose of Review The neurogenic bladder is a medical term that describes a variety of bladder and sphincter dysfunctions. There are two major dangerous functional problems in a child with neurogenic bladder: high intravesical pressure in the storage phase and high pressure during urination. Two basic goals for urologic treatment in those children are protection of urinary tract from complications and improvement of continence in older children. This review focuses on the current role of botulinum toxin treatment in children with neurogenic bladder. Recent Findings At the beginning, treatment in this group of children is conservative. Oral anticholinergic therapy is aimed at decreasing bladder pressures during the storage phase. Clean intermittent catheterization enables bladder emptying if voiding is insufficient. Nevertheless, in a number of children such an approach fails, in some patients, troublesome side effects occur. In cases when standard therapy provides no improvement or if complications develop on the proper conservative treatment, surgical procedures are suggested. Operations are aimed at the surgical enlargement of bladder capacity. There are some reports on the efficacy of cystoscopic detrusor botulinum toxin injections in the treatment of neurogenic bladder in children. Summary Cystoscopic administration of botulinum toxin represents an alternative method of treatment to surgery for children with neurogenic bladder and could be considered an alternative to oral anticholinergic therapy.

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Predicting outcomes after intradetrusor onabotulinumtoxina for non‐neurogenic urgency incontinence in women

Hendrickson

Xie

Rahn

et al. 2021

Neurourology and Urodynamics

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Aims: Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI).Methods: Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months. Model discrimination of Cox and logistic regression models was calculated using c-index. Mean absolute error determined accuracy of the linear model. Calibration was demonstrated using calibration curves. All models were internally validated using bootstrapping.Results: Median time to recurrence was 6 (interquartile range [IQR]: 2-12) months. Increasing age, 200 units of onabotulinumtoxinA, higher body mass index (BMI) and baseline UUIE were associated with decreased time to recurrence. The c-index was 0.63 (95% confidence interval [CI]: 0.59, 0.67). Median change in daily UUIE from baseline at 6 months was −3.5 (IQR: −5.0, −2.3). Increasing age, lower baseline UUIE, 200 units of onabotulinumtoxinA, higher BMI and IIQ-SF were associated with less improvement in UUIE. The mean absolute error predicting change in UUIE was accurate to 1.6 (95% CI:1.5, 1.7) UUI episodes. The overall rate of self-catheterization was 17.6% (95% CI: 13.6%-22.4%). Lower BMI, 200 units of onabotulinumtoxinA, increased baseline postvoid residual and maximum capacity were associated with higher risk of self-catheterization. The c-index was 0.66 (95% CI: 0.61, 0.76). The three calculators are available at http://riskcalc.duke.edu.

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A systematic review and meta-analysis of effectiveness and safety of therapy for overactive bladder using botulinum toxin A at different dosages

Cited by 16 publications

References 54 publications

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

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

The Current Role of Botox in a Pediatric Neurogenic Bladder Condition

Predicting outcomes after intradetrusor onabotulinumtoxina for non‐neurogenic urgency incontinence in women

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