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Trigonal versus extratrigonal botulinum toxin-A: a systematic review and meta-analysis of efficacy and adverse events

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Abstract

Introduction and hypothesis

Botulinum toxin-A (BoNT-A) is a potent neurotoxin that is an effective treatment for patients with pharmacologically refractory detrusor overactivity (DO). Data assessing the effectiveness of trigonal BoNT-A are limited. This study evaluates adverse events (AEs) and short-term efficacy associated with trigonal and extratrigonal BoNT-A.

Methods

Electronic databases (PubMed, EMBASE, and the Cochrane database) were searched for studies comparing trigonal and extratrigonal BoNT-A for DO. Meta-analyses were performed using the random effects model. Outcome measures included incidence of AEs and short-term efficacy.

Results

Six studies describing 258 patients met the inclusion criteria. The meta-analysis did not show significant differences between trigonal and extratrigonal BoNT-A for acute urinary retention (AUR; 4.2 vs 3.7 %; odds ratio [OR]: 1.068, 95 % confidence interval [CI]: 0.239–4.773; P =  0.931) or high post-void residual (PVR; 25.8 vs 22.2 %; OR: 0.979; 95 % CI: 0.459–2.088; P =  0.956). The incidence of urinary tract infection (UTI; 7.5 vs 21.0 %; OR: 0.670; 95 % CI: 0.312–1.439; P =  0.305), haematuria (15.8 vs 25.9 %; OR: 0.547; 95 % CI: 0.264–1.134; P =  0.105) and post-operative muscle weakness (9.2 vs 11.3 %; OR: 0.587; 95 % CI: 0.205–1.680, P =  0.320) was similar in both groups. Finally, differences in short-term cure rates between two study arms were not statistically significant (52.9 vs 56.9 %; OR: 1.438; 95 % CI: 0.448–4.610; P =  0.542).

Conclusions

Although data are limited, no significant differences between trigonal and extratrigonal BoNT-A in terms of AEs and short-term efficacy were observed. Additional randomised controlled trials are required to define optimal injection techniques and sites for administering intra-vesical BoNT-A.

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Abbreviations

AEs:

Adverse events

AUR:

Acute urinary retention

BoNT-A:

Botulinum toxin-A

DO:

Detrusor overactivity

DSD:

Detrusor sphincter dysynergia

IDO:

Idiopathic detrusor overactivity

NDO:

Neurogenic detrusor overactivity

OAB:

Overactive bladder

QoL:

Quality of life

SIC:

Self intermittent catheterisation

UTI:

Urinary tract infection

VUR:

Vesicoureteric reflux

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Acknowledgements

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Author participation

Niall Davis: collection of data, manuscript writing; John Burke: statistical analysis; Elaine Redmond: collection of data; Saif Elamin: collection of data; Ciaran Brady: manuscript editing; Hugh Flood: project design, manuscript editing.

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Authors and Affiliations

  1. Department of Urology, Mercy University Hospital, Cork City, Co Cork, Ireland

    N. F. Davis, J. P. Burke, S. Elamin & C. M. Brady

  2. Department of Urology, University of Limerick Teaching Hospital, Dooradoyle, Limerick, Ireland

    E. J. Redmond & H. D. Flood

Authors
  1. N. F. Davis
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  2. J. P. Burke
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  3. E. J. Redmond
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  4. S. Elamin
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  5. C. M. Brady
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  6. H. D. Flood
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Correspondence to N. F. Davis.

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Davis, N.F., Burke, J.P., Redmond, E.J. et al. Trigonal versus extratrigonal botulinum toxin-A: a systematic review and meta-analysis of efficacy and adverse events. Int Urogynecol J 26, 313–319 (2015). https://doi.org/10.1007/s00192-014-2499-2

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  • DOI: https://doi.org/10.1007/s00192-014-2499-2

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