Clinical outcomes of botulinum toxin A management for neurogenic detrusor overactivity: meta-analysis

Abstract

The aim of this work was to evaluate the efficacy and safety of botulinum toxin A (BTX-A) treatment in patients with neurogenic detrusor overactivity. PUBMED, EMBASE, and Cochrane Library were identified on 13 May 2017 to identify relevant randomized controlled trials. All data obtained were analyzed using Stata 12.0. Five randomized controlled trials were included in this study. Compared to placebo, the BTX-A groups had significantly fewer urinary incontinence (UI) episodes per day and per week (BTX-A with 300 U for frequency of UI per day at week 2, mean difference (MD): −1.13, 95% confidence interval (CI): −1.89 to −0.37; 200 U; BTX-A with 300 U for frequency of UI per week at week 6, MD: −11.42, 95% CI: −13.91 to −8.93; BTX-A with 200 U for frequency of UI per week at week 6, MD: −10.72, 95% CI: −13.40 to −8.04), increased in maximum cystometric capacity at week 6 (BTX-A with 300 U, MD: 154.88, 95% CI: 133.92–175.84; BTX-A with 200 U, MD: 141.30, 95% CI: 121.28–161.33), decreased maximum detrusor pressure at week 6 (BTX-A with 300 U, MD: −31.72, 95% CI: −37.69 to −25.75; BTX-A with 200 U, MD: −33.47, 95% CI: −39.20 to −27.73). For adverse effects, BTX-A was often associated with more complications and urinary tract infections (BTX-A with 300 U: relative risk (RR):1.42, 95% CI: 1.15–1.76; BTX-A with 200 U: RR: 1.42, 95% CI: 1.11–1.82). This meta-analysis suggests that treatment with BTX-A is effective and safe for neurogenic detrusor overactivity, and recommends using BTX-A with 300 U or with 200 U, as suitable dosage.

Quality of Life in Female Patients with Overactive Bladder after Botulinum Toxin Treatment

“…According to Cheng et al [ 46 ], the mean frequency of incontinence episodes in patients with NDO treated with onabotulinum toxin decreased significantly at week 6 post-injection as compared with placebo. Those findings are consistent with the results of other meta-analyses published by Wu et al [ 47 ], Zhou et al [ 48 ], and Yuan et al [ 49 ]. Additionally, Cheng et al [ 46 ] found no significant differences in the effectiveness of botulinum toxin administered at 200 and 300 units, which is in agreement with the results of meta-analyses published by Zhang et al [ 50 ], Wu et al [ 47 ], and Gu et al [ 51 ].…”

“…Those findings are consistent with the results of other meta-analyses published by Wu et al [47], Zhou et al [48], and Yuan et al [49]. Additionally, Cheng et al [46] found no significant differences in the effectiveness of botulinum toxin administered at 200 and 300 units, which is in agreement with the results of meta-analyses published by Zhang et al [50], Wu et al [47], and Gu et al [51]. Kennelly et al [52] published the results of a long-term study analyzing the effectiveness and safety of botulinum toxin treatment during a four-year follow-up.…”

Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials

“…Treatment should be tailored to the individual patient, also considering that conventional treatment programs for non-neurogenic OAB could lack clinical efficacy in neurogenic patients. Several systematic reviews have been published in the last 15 years to evaluate the evidence concerning the different treatments for neurogenic OAB (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In 2012, Madhuvrata and coworkers (2) published a systematic review and meta-analysis on anticholinergic treatment of adult neurogenic OAB, which updated and completed a previous systematic review assessing the efficacy and tolerability of anticholinergic agents in patients with OAB associated to multiple sclerosis (3).…”

“…A meta-analysis evaluated the results of studies focusing on sacral neuromodulation (SNM) in patients with neurogenic lower urinary tract dysfunction (8). Finally, several systematic reviews with metanalysis evaluated the treatment of overactive bladder syndrome with Botulinum toxin injection (9)(10)(11)(12)(13)(14)(15). Although a relevant bulk of information from previous systematic reviews is available, certain specific aspects, such as efficacy mirabegron and new anticholinergic agents in neurogenic bladder have not yet been addressed.…”

Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury

“…Antimuscarinics and β3-adrenoceptor agonist can reduce detrusor overactivity and lower intravesical pressure [ 138 , 139 ]. The clinical efficacy of intravesical botulinum toxin A injection after failure of medication has been demonstrated [ 140 ]. Surgeries such as augmentation cystoplasty is indicated in patients’ refractory to conservative treatments.…”