Skip to main content


Log in

Efficacy and duration of response to botulinum neurotoxin A (onabotulinumA) as a treatment for detrusor overactivity in women

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript


Introduction and hypothesis

Overactive bladder syndrome with urinary incontinence has a number of treatment options. The National Institute for Health and Care Excellence (NICE) in the UK, the American Urological Association (AUA) and the European Association of Urology (EAU) recommend intradetrusor botulinum neurotoxin A (onabotulinumA) injections in women with proven detrusor overactivity (DO) in whom conservative therapies have failed to improve symptoms. However, the effects of individual onabotulinumA treatments are of short duration and patients usually require further treatments. There is little evidence to inform long-term management strategies using onabotulinumA for DO.


A retrospective review of patients receiving intradetrusor onabotulinumA injections for DO over a 7-year period was conducted. The primary outcome measures included patient’s subjective reports of symptom change following injections (efficacy) and the duration of symptomatic relief following each treatment.


The analysis included 136 patients. The mean time between patients receiving intradetrusor onabotulinumA and being added to the surgical waiting list for re-treatment varied between 8.5 and 10.4 months for the first five cycles of treatment with the longest time between the third and fourth cycles. This decreased to 5.5 and 5.25 (ANOVA p = 0.015) between the fifth and sixth cycles and between the sixth and seventh cycles of treatment, respectively. Only 19.9 % of patients continued treatment beyond this, with four patients receiving a seventh treatment.


Our results suggest that in patients who respond to onabotulinumA treatment, the duration of response declines after the fifth treatment, suggesting a possible tolerance effect and a subsequent decline in efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29(1):4–20

    PubMed  Google Scholar 

  2. Tubaro A (2004) Defining overactive bladder: epidemiology and burden of disease. Urology 64(6 Suppl 1):2–6

    Article  PubMed  Google Scholar 

  3. Roxburgh C, Cook J, Dublin N (2007) Anticholinergic drugs versus other medications for overactive bladder syndrome in adults. Cochrane Database Syst Rev 4:CD003190

    PubMed  Google Scholar 

  4. Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D (2011) Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev 12:CD005493

    PubMed  Google Scholar 

  5. Dmochowski R, Sand PK (2007) Botulinum toxin A in the overactive bladder: current status and future directions. BJU Int 99(2):247–262

    Article  CAS  PubMed  Google Scholar 

  6. Nitti VW (2006) Botulinum toxin for the treatment of idiopathic and neurogenic overactive bladder: state of the art. Rev Urol 8(4):198–208

    PubMed Central  PubMed  Google Scholar 

  7. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ et al (2012) Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol 188(6 Suppl):2455–2463

    Article  PubMed  Google Scholar 

  8. Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK et al (2012) EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol 62(6):1130–1142

    Article  PubMed  Google Scholar 

  9. National Collaborating Centre for Women's and Children's Health (UK) (2013) NICE Clinical Guideline No. 171: The management of urinary incontinence in women. London: National Institute for Health and Care Excellence

  10. National Collaborating Centre for Women's and Children's Health (UK) (2006) NICE Clinical Guideline No. 40: The management of urinary incontinence in women. London: National Institute for Health and Care Excellence

  11. Rechberger T, Parsons M, Guard S, Zheng Y, Ginsberg D (2014) Repeat treatments with onabotulinumtoxina provide long-term improvements in symptoms of overactive bladder in female patients with urinary incontinence who are inadequately managed by an anticholinergic. Int Urogynecol J 25(Suppl 1):S1–S240

    Google Scholar 

  12. Grosse J, Kramer G, Stohrer M (2005) Success of repeat detrusor injections of botulinum a toxin in patients with severe neurogenic detrusor overactivity and incontinence. Eur Urol 47(5):653–659

    Article  CAS  PubMed  Google Scholar 

  13. Smith CP, Nishiguchi J, O'Leary M, Yoshimura N, Chancellor MB (2005) Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology 65(1):37–41

    Article  PubMed  Google Scholar 

  14. Ruffion A, Capelle O, Paparel P, Leriche B, Leriche A, Grise P (2006) What is the optimum dose of type A botulinum toxin for treating neurogenic bladder overactivity? BJU Int 97(5):1030–1034

    Article  CAS  PubMed  Google Scholar 

  15. Karsenty G, Reitz A, Lindemann G, Boy S, Schurch B (2006) Persistence of therapeutic effect after repeated injections of botulinum toxin type A to treat incontinence due to neurogenic detrusor overactivity. Urology 68(6):1193–1197

    Article  PubMed  Google Scholar 

  16. Reitz A, Denys P, Fermanian C, Schurch B, Comperat E, Chartier-Kastler E (2007) Do repeat intradetrusor botulinum toxin type a injections yield valuable results? Clinical and urodynamic results after five injections in patients with neurogenic detrusor overactivity. Eur Urol 52(6):1729–1735

    Article  PubMed  Google Scholar 

  17. Del Popolo G, Filocamo MT, Li Marzi V, Macchiarella A, Cecconi F, Lombardi G et al (2008) Neurogenic detrusor overactivity treated with English botulinum toxin A: 8-year experience of one single centre. Eur Urol 53(5):1013–1019

    Article  PubMed  Google Scholar 

  18. Tincello DG, Owen RK, Slack MC, Mayne C, Toozs-Hobson P, Abrams KR (2014) Efficacy of repeat treatment with onabotulinum toxin for refractory detrusor overactivity: secondary analysis of open label extension of a randomised trial. Int Urogynecol J 25(Suppl 1):S1–S240

    Google Scholar 

  19. Dromerick AW, Edwards DF (2003) Relation of postvoid residual to urinary tract infection during stroke rehabilitation. Arch Phys Med Rehabil 84(9):1369–1372

    Article  PubMed  Google Scholar 

  20. Brubaker L, Richter HE, Visco A, Mahajan S, Nygaard I, Braun TM et al (2008) Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol 180(1):217–222

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflicts of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Paul Hilton.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chohan, N., Hilton, P., Brown, K. et al. Efficacy and duration of response to botulinum neurotoxin A (onabotulinumA) as a treatment for detrusor overactivity in women. Int Urogynecol J 26, 1605–1612 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: