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Treatment for refractory overactive bladder: a systematic review and meta-analysis of sacral neuromodulation and onabotulinumtoxinA

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Abstract

Introduction and hypothesis

This systematic review and meta-analysis aim to evaluate the outcomes between SNM and BTX in the treatment of refractory OAB.

Methods

PubMed, Embase, and CENTRAL were comprehensively searched from their inception to December 2019. Randomized and nonrandomized controlled trials evaluating OAB patients who underwent SNM and BTX were included. Data extraction and quality assessment were conducted by two independent reviewers. The outcomes, side effects, and cost-effectiveness values of both procedures were compared in meta-analysis.

Results

This review involved six articles (2629 patients). Specifically, three articles were based on the same trial, and the other studies were retrospective cohort studies. No significant difference was found in successful treatment between BTX and SNM at 6 months after procedures [risk ratio (RR) = 0.93, 95% confidence interval (CI) 0.63–1.39]. BTX exhibited a significantly higher total adverse event rate than SNM through 6 months (RR = 1.55, 95% CI 1.28–1.88). Patients suffered more urinary tract infection (UTI) risk under BTX injection at the early stage (RR = 1.58, 95% CI 1.10–2.25); however, the difference in UTI events was not significant between the two groups (RR = 1.13, 95% CI 1.10–2.25) during the period of 7–12 months postoperatively. Obviously, the short-term cost (1–2 years) of BTX was significantly lower than that of the SNM procedure.

Conclusions

Both treatments were effective; however, because of the high complication rate of BTX, it may not be a better way to treat refractory OAB than SNM, although BTX is more cost-effective for short-term treatment at present.

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Abbreviations

OAB:

Overactive bladder

QoL:

Quality of life

UUI:

Urgency urinary incontinence

BTX:

OnabotulinumtoxinA

SNM:

Sacral neuromodulation

RCT:

Randomized controlled trial

CI:

Confidence interval

LE:

Level of evidence

RR:

Risk ratio

AE:

Adverse event

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Acknowledgements

This study was supported by grant nos. 81873601 and 81770673 from the National Natural Science Foundation of China and grant no. ZYGD18011 and ZY2017310 from the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.

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Author notes

  1. Qing He and Boya Li contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, People’s Republic of China

    Qing He, Boya Li, Chi Zhang, Jie Zhang, Deyi Luo & Kunjie Wang

Authors
  1. Qing He
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  2. Boya Li
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  3. Chi Zhang
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  4. Jie Zhang
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  5. Deyi Luo
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Contributions

Q He: Data collection, Manuscript writing.

BY Li: Data collection, Manuscript writing.

C Zhang: Data analysis.

J Zhang: Data analysis.

DY Luo: Project development, Manuscript editing.

KJ Wang: Project development, Manuscript editing.

Corresponding authors

Correspondence to Deyi Luo or Kunjie Wang.

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He, Q., Li, B., Zhang, C. et al. Treatment for refractory overactive bladder: a systematic review and meta-analysis of sacral neuromodulation and onabotulinumtoxinA. Int Urogynecol J 32, 477–484 (2021). https://doi.org/10.1007/s00192-020-04427-w

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  • DOI: https://doi.org/10.1007/s00192-020-04427-w

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