Skip to main content
SpringerLink
Log in

Treatment Options in Patients with Overactive Bladder: The Invasive Management

  • Chapter
  • First Online:
Non-Neurogenic Bladder Dysfunctions

Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

  • 332 Accesses

Abstract

Several conventional, minimally invasive or surgical procedures can be offered to treat idiopathic overactive bladder (OAB) when conservative and oral pharmacological treatments fail. Onabotulinum toxin A (OnaBoNTA) has proven to be more effective than muscarinic receptor antagonists with a high cure rate, as well as safe for frail and elderly people. Patients should be involved in the decision-making process, conscious of the individual risk of adverse events especially with regards to urinary retention and the risk of urinary tract infections (25%). The presence of voiding dysfunction before treatment increases the risk of having to start intermittent catheterization after BoNTA. Subjects with higher post-void residual at baseline are at major risk of developing symptomatic urinary retention post-injection. Sacral neuromodulation (SNM) is a valid alternative to BoNTA. Although OnaBoNTA has shown to be more effective than SNM in short-term follow-up (6 months), comparable outcomes are achieved at 2-year follow-up. However, all patients who are SNM candidates for idiopathic urgency urinary incontinence should be preliminarily tested (PNE and/or I stage SNM) to evaluate the harm and benefits of a definitive implant. Only those who show a significant improvement of at least 50% should be implanted. Percutaneous tibial nerve stimulation (PTNS) is the least invasive form of conventional neuromodulation recommended for OAB syndrome. Bladder augmentation or incontinent stoma should be a last resort for patients with proven failure for all possible lesser invasive treatments.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    Article  PubMed  Google Scholar 

  2. Janicki JJ, Chancellor MB, Kaufman J, Gruber MA, Chancellor DD. Potential effect of liposomes and liposome-encapsulated botulinum toxin and tacrolimus in the treatment of bladder dysfunction. Toxins (Basel). 2016;8(3):81.

    Article  CAS  Google Scholar 

  3. Lee W, Su C, Tain Y, et al. Potential orphan drug therapy of intravesical liposomal onabotulinumtoxin-A for ketamine-induced cystitis by mucosal protection and anti-inflammation in a rat model. Sci Rep. 2018;8:5795.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Kumar R, Dhaliwal HP, Kukreja RV, Singh BR. The botulinum toxin as a therapeutic agent: molecular structure and mechanism of action in motor and sensory systems. Semin Neurol. 2016;36(1):10–9.

    Article  PubMed  Google Scholar 

  5. Jhang J-F, Kuo H-C. Botulinum toxin A and lower urinary tract dysfunction: pathophysiology and mechanisms of action. Toxins (Basel). 2016;8(4):120.

    Article  CAS  Google Scholar 

  6. Ikeda Y, Zabbarova IV, Birder LA, de Groat WC, McCarthy CJ, Hanna-Mitchell AT, et al. Botulinum neurotoxin serotype A suppresses neurotransmitter release from afferent as well as efferent nerves in the urinary bladder. Eur Urol. 2012;62(6):1157–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Jhang J-F, Kuo H-C. Botulinum toxin A and lower urinary tract dysfunction: pathophysiology and mechanisms of action. Toxins (Basel). 2016;8(4):120.

    Article  CAS  Google Scholar 

  8. Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2018;73(4):596–609.

    Article  PubMed  Google Scholar 

  9. Nitti VW, Dmochowski R, Herschorn S, Sand P, Thompson C, Nardo C, et al. Onabotulinumtoxin A for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol. 2013;189(6):2186–93.

    Article  CAS  PubMed  Google Scholar 

  10. Visco AG, Brubaker L, Richter HE, Nygaard I, Paraiso MFR, Menefee SA, et al. Anticholinergic therapy vs. onabotulinumtoxina for urgency urinary incontinence. N Engl J Med. 2012;367(19):1803–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Herschorn S, Kohan A, Aliotta P, McCammon K, Sriram R, Abrams S, et al. The efficacy and safety of onabotulinumtoxinA or solifenacin compared with placebo in solifenacin naive patients with refractory overactive bladder: results from a multicenter, randomized, double-blind phase 3b trial. J Urol. 2017;198(1):167–75.

    Article  CAS  PubMed  Google Scholar 

  12. Nitti VW, Ginsberg D, Sievert K-D, Sussman D, Radomski S, Sand P, et al. Durable efficacy and safety of long-term onabotulinumtoxinA treatment in patients with overactive bladder syndrome: final results of a 3.5-year study. J Urol. 2016;196(3):791–800.

    Article  CAS  PubMed  Google Scholar 

  13. Stamm AW, Adelstein SA, Chen A, Lucioni A, Kobashi KC, Lee UJ. Inconsistency in the definition of urinary tract infection after intravesical botulinum toxin A injection: a systematic review. J Urol. 2018;200(4):809–14.

    Article  CAS  PubMed  Google Scholar 

  14. Kuo HC, Liao CH, Chung SD. Adverse events of intravesical botulinum toxin A injections for idiopathic detrusor overactivity: risk factors and influence on treatment outcome. Eur Urol. 2010;58(6):919–26.

    Article  CAS  PubMed  Google Scholar 

  15. Osborn DJ, Kaufman MR, Mock S, Guan MJ, Dmochowski RR, Reynolds WS. Urinary retention rates after intravesical onabotulinumtoxinA injection for idiopathic overactive bladder in clinical practice and predictors of this outcome. Neurourol Urodyn. 2015;34(7):675–8.

    Article  CAS  PubMed  Google Scholar 

  16. Tanagho EA, Schmidt RA. Bladder pacemaker: scientific basis and clinical future. Urology. 1982;20(6):614–9.

    Article  CAS  PubMed  Google Scholar 

  17. Banakhar M, Hassouna M. Percutaneous nerve evaluation test versus staged test trials for sacral neuromodulation: sensitivity, specificity, and predictive values of each technique. Int Neurourol J. 2016;20(3):250–4.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bannowsky A, Wefer B, Braun PM, Junemann K-P. Urodynamic changes and response rates in patients treated with permanent electrodes compared to conventional wire electrodes in the peripheral nerve evaluation test. World J Urol. 2008;26(6):623–6.

    Article  PubMed  Google Scholar 

  19. Spinelli M, Giardiello G, Gerber M, Arduini A, van den Hombergh U, Malaguti S. New sacral neuromodulation lead for percutaneous implantation using local anesthesia: description and first experience. J Urol. 2003;170(5):1905–7.

    Article  PubMed  Google Scholar 

  20. De Wachter S, Vaganee D, Kessler TM. Sacral neuromodulation: mechanism of action. Eur Urol Focus. 2020;2020:S2405-4569(19)30366-9.

    Google Scholar 

  21. Leng WW, Chancellor MB. How sacral nerve stimulation neuromodulation works. Urol Clin North Am. 2005;32(1):11–8.

    Article  PubMed  Google Scholar 

  22. Blok BFM, Groen J, Bosch JLHR, Veltman DJ, Lammertsma AA. Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int. 2006;98(6):1238–43.

    Article  PubMed  Google Scholar 

  23. Herbison GP, Arnold EP. Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults. Cochrane Database Syst Rev. 2009;2:CD004202.

    Google Scholar 

  24. Brazzelli M, Murray A, Fraser C. Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review. J Urol. 2006;175(3 Pt 1):835–41.

    Article  PubMed  Google Scholar 

  25. Siegel S, Noblett K, Mangel J, Griebling TL, Sutherland SE, Bird ET, et al. Three-year follow-up results of a prospective, multicenter study in overactive bladder subjects treated with sacral neuromodulation. Urology. 2016;94:57–63.

    Article  PubMed  Google Scholar 

  26. Amundsen CL, Komesu YM, Chermansky C, Gregory WT, Myers DL, Honeycutt EF, Vasavada SP, Nguyen JN, Wilson TS, Harvie HS, Wallace D, For the Pelvic Floor Disorders Network. Two-year outcomes of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: a randomized trial. Eur Urol. 2018;74(1):66–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Richter HE, Amundsen CL, Erickson SW, Jelovsek JE, Komesu Y, Chermansky C, Harvie H, Albo M, Myers D, Gregory WT, Wallace D, for the NICHD Pelvic Floor Disorders Network. Characteristics associated with treatment response in women undergoing onabotulinumtoxina and sacral neuromodulation for refractory urgency urinary incontinence. J Urol. 2017;198(4):890–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Andy UU, Amundsen CL, Honeycutt E, et al. Sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: impact on fecal incontinence symptoms and sexual function. Am J Obstet Gynecol. 2019;221(5):513.e1–513.e15.

    Article  CAS  Google Scholar 

  29. Al-zahrani AA, Elzayat EA, Gajewski JB. Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center. J Urol. 2011;185(3):981–6.

    Article  PubMed  Google Scholar 

  30. McCrery R, Lane F, Benson K, et al. Treatment of urinary urgency incontinence using a rechargeable SNM system: 6-month results of the ARTISAN-SNM study. J Urol. 2020;203(1):185–92.

    Article  PubMed  Google Scholar 

  31. Blok B, Van Kerrebroeck P, de Wachter S, et al. A prospective, multicenter study of a novel, miniaturized rechargeable sacral neuromodulation system: 12-month results from the RELAX-OAB study. Neurourol Urodyn. 2019;38(2):689–95.

    Article  PubMed  Google Scholar 

  32. Blok B, Van Kerrebroeck P, de Wachter S, et al. Programming settings and recharge interval in a prospective study of a rechargeable sacral neuromodulation system for the treatment of overactive bladder. Neurourol Urodyn. 2018;37(S2):S17–22.

    Article  CAS  PubMed  Google Scholar 

  33. Giani I, Musco S. Tibial nerve stimulation. In: Martellucci J, editor. Electrical stimulation for pelvic floor disorders. Cham: Springer; 2015.

    Google Scholar 

  34. Booth J, Aucott L, Cotton S, et al. ELECtric tibial nerve stimulation to reduce incontinence in care homes: protocol for the ELECTRIC randomised trial. Trials. 2019;20:723.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Ramírez-García I, Blanco-Ratto L, Kauffmann S, Carralero-Martínez A, Sánchez E. Efficacy of transcutaneous stimulation of the posterior tibial nerve compared to percutaneous stimulation in idiopathic overactive bladder syndrome: randomized control trial. Neurourol Urodyn. 2019;38(1):261–8.

    Article  PubMed  CAS  Google Scholar 

  36. Finazzi-Agrò E, Petta F, Sciobica F, Pasqualetti P, Musco S, Bove P. Percutaneous tibial nerve stimulation effects on detrusor overactivity incontinence are not due to a placebo effect: a randomized, double-blind, placebo controlled trial. J Urol. 2010;184(5):2001–6.

    Article  PubMed  Google Scholar 

  37. Peters KM, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol. 2009;182(3):1055–61.

    Article  CAS  PubMed  Google Scholar 

  38. Vandoninck V, van Balken MR, Finazzi Agrò E, et al. Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn. 2003;22(3):227–32.

    Article  PubMed  Google Scholar 

  39. Peters KM, Carrico DJ, MacDiarmid SA, et al. Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. Neurourol Urodyn. 2013;32(1):24–9.

    Article  PubMed  Google Scholar 

  40. Vollstedt A, Gilleran J. Update on implantable PTNS devices. Curr Urol Rep. 2020;21(7):28. https://doi.org/10.1007/s11934-020-00980-5.

    Article  PubMed  Google Scholar 

  41. Abrams P, Andersson K-E, Apostolidis A, Birder L, Bliss D, Brubaker L, et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn. 2018;37(7):2271–2.

    Article  PubMed  Google Scholar 

  42. Greenwell TJ, Venn SN, Mundy AR. Augmentation cystoplasty. BJU Int. 2001;88(6):511–25.

    Article  CAS  PubMed  Google Scholar 

  43. El-Azab AS, Moeen AM. The satisfaction of patients with refractory idiopathic overactive bladder with onabotulinumtoxinA and augmentation cystoplasty. Arab J Urol. 2013;11(4):344–9.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Stein R, Schroder A, Thuroff JW. Bladder augmentation and urinary diversion in patients with neurogenic bladder: non-surgical considerations. J Pediatr Urol. 2012;8(2):145–52.

    Article  PubMed  Google Scholar 

  45. Biardeau X, Chartier-Kastler E, Roupret M, Phe V. Risk of malignancy after augmentation cystoplasty: a systematic review. Neurourol Urodyn. 2016;35(6):675–82.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuro-Urology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Musco Stefania & Del Popolo Giulio

  2. Urology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Gemma Luca

Authors
  1. Musco Stefania
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gemma Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Del Popolo Giulio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Musco Stefania .

Editor information

Editors and Affiliations

  1. Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

    Matteo Balzarro

  2. Unit of Minimally Invasive, Robotic Urologic Surgery and Kidney Transplantation, Department of Experimental Medicine, Careggi Hospital, University of Florence, Florence, Italy

    Vincenzo Li Marzi

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Stefania, M., Luca, G., Giulio, D.P. (2021). Treatment Options in Patients with Overactive Bladder: The Invasive Management. In: Balzarro, M., Li Marzi, V. (eds) Non-Neurogenic Bladder Dysfunctions. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-030-57393-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-57393-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57392-8

  • Online ISBN: 978-3-030-57393-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation