Outcomes of Intravesical Botulinum Toxin for Idiopathic Overactive Bladder Symptoms: A Systematic Review of the Literature
- 30 June 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 183 (6), 2258-2264
- https://doi.org/10.1016/j.juro.2010.02.009
Abstract
Purpose: We systematically reviewed the evidence for the efficacy and safety of botulinum toxin in the management of overactive bladder. Materials and Methods: We performed a systematic review of the literature to identify articles published between 1985 and March 2009 on intravesical botulinum toxin-A injections for the treatment of refractory idiopathic overactive bladder in men and women. Databases searched included MEDLINE®, CENTRAL and Embase®. Data were tabulated from case series and from randomized controlled trials, and data were pooled where appropriate. Results: Our literature search identified 432 titles and 23 full articles were included in the final review. Three randomized placebo controlled trials addressing the use of botulinum toxin-A were identified (99 patients total). The pooled random effects estimate of effect across all 3 studies was 3.88 (95% CI −6.15, −1.62), meaning that patients treated with botulinum toxin-A had 3.88 fewer incontinence episodes per day. Urogenital Distress Inventory data revealed significant improvements in quality of life compared with placebo with a standardized mean difference of −0.62 (CI −1.04, −0.21). Data from case series demonstrated significant improvements in overactive bladder symptoms and quality of life, despite heterogeneity in methodology and case mix. However, based on the randomized controlled trials there was a 9-fold increased odds of increased post-void residual after botulinum toxin-A compared with placebo (8.55; 95% CI 3.22, 22.71). Conclusions: Intravesical injection of botulinum toxin resulted in improvement in medication refractory overactive bladder symptoms. However, the risk of increased post-void residual and symptomatic urinary retention was significant. Several questions remain concerning the optimal administration of botulinum toxin-A for the patient with overactive bladder.Keywords
This publication has 19 references indexed in Scilit:
- Outcome of a Randomized, Double-Blind, Placebo Controlled Trial of Botulinum A Toxin for Refractory Overactive BladderJournal of Urology, 2009
- Refractory Idiopathic Urge Urinary Incontinence and Botulinum A InjectionJournal of Urology, 2008
- Efficacy of Botulinum Toxin-A for Treating Idiopathic Detrusor Overactivity: Results From a Single Center, Randomized, Double-Blind, Placebo Controlled TrialJournal of Urology, 2007
- Botulinum toxin injections for adults with overactive bladder syndromePublished by Wiley ,2005
- Measuring inconsistency in meta-analysesBMJ, 2003
- Methods to Explain the Clinical Significance of Health Status MeasuresMayo Clinic Proceedings, 2002
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986
- Beta blockade during and after myocardial infarction: An overview of the randomized trialsProgress in Cardiovascular Diseases, 1985