Comparing the Efficacy of OnabotulinumtoxinA, Sacral Neuromodulation, and Peripheral Tibial Nerve Stimulation as Third Line Treatment for the Management of Overactive Bladder Symptoms in Adults: Systematic Review and Network Meta-Analysis

Abstract

The American Urological Association guidelines for the management of non-neurogenic overactive bladder (OAB) recommend the use of OnabotulinumtoxinA, sacral neuromodulation (SNM), and peripheral tibial nerve stimulation (PTNS) as third line treatment options with no treatment hierarchy. The current study used network meta-analysis to compare the efficacy of these three modalities for managing adult OAB syndrome. We performed systematic literature searches of several databases from January 1995 to September 2019 with language restricted to English. All randomized control trials that compared any dose of OnabotulinumtoxinA, SNM, and PTNS with each other or a placebo for the management of adult OAB were included in the study. Overall, 17 randomized control trials, with a follow up of 3–6 months in the predominance of trials (range 1.5–24 months), were included for analysis. For each trial outcome, the results were reported as an average number of episodes of the outcome at baseline. Compared with the placebo, all three treatments were more efficacious for the selected outcome parameters. OnabotulinumtoxinA resulted in a higher number of complications, including urinary tract infection and urine retention. Compared with OnabotulinumtoxinA and PTNS, SNM resulted in the greatest reduction in urinary incontinence episodes and voiding frequency. However, comparison of their long-term efficacy was lacking. Further studies on the long-term effectiveness of the three treatment options, with standardized questionnaires and parameters are warranted.

Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women

“…The indications include detrusor underactivity, neurogenic detrusor sphincter dyssynergia, and non-neurogenic DV. Although most studies demonstrated the efficacy of this treatment in voiding dysfunction caused by urethral sphincter hyperactivity of different etiologies, the subjective improvement rate after BoNT-A urethral sphincter injection was only 60% [ 13 , 14 , 19 ]. In the experience of the authors for the present study, patients who have an open BN on voiding cystourethrography have predictably successful therapeutic results [ 14 ].…”

“…Many treatment modalities have been used to relax the urethral sphincter and pelvic floor muscles, including pelvic floor muscle training, antimuscarinic therapy, sacral nerve neuromodulation, and posterior tibial nerve stimulation [ 5 , 11 , 12 ]. Since no definitive medical treatment is currently available for DV, clinicians have enthusiastically used urethral botulinum toxin A (BoNT-A) for this off-label indication [ 13 ]. However, a satisfactory treatment outcome with BoNT-A has not been achievable for all patients with DV [ 14 ].…”

The efficacy and safety of Vibegron in treating overactive bladder: A systematic review and pooled analysis of randomized controlled trials

“…A number of neurotransmitters and neural pathways are participated in the control of bladder urine storage and subsequent emptying, and undermine these neurotransmitters and neural pathways may cause the dysfunction of vesical. Generally, OAB is considered to be caused by the vesical detrusor muscle' overactivity, resulting in the suddenly contracting of vesical, although the vesical is not filled 22 . Vibegron is a new β3‐adrenergic receptor agonist.…”

Diagnosis and management of overactive bladder: A review

“…Approved third‐line treatment options for OAB include onabotulinumtoxinA, peripheral tibial nerve stimulation (PTNS), and sacral nerve stimulation (SNS) 75 . Each option demonstrates significant benefit in controlling urinary symptoms versus placebo/sham treatment 76 . Patients should be carefully monitored and counseled appropriately based on the advantages and disadvantages of the individual treatments.…”