Study design: Systematic review. Objective: To evaluate effectiveness and adverse effects of botulinum toxin (BTX) for treatment of urinary incontinence (UI) due to detrusor overactivity (DO). Methods: Randomized controlled trials published in English before November 2006 were included if they enrolled subjects with UI caused by DO and reported incontinence outcomes. Results: Three trials totaling 104 subjects with DO refractory to antimuscarinic treatment were included. Two BTX-A trials enrolled primarily patients with NDO secondary to spinal cord injury (SCI) (93%). BTX-A decreased daily UI episodes compared to placebo but the reductions were only significantly different at a few of the time intervals during 24 weeks of follow-up. BTX-A was superior in reducing daily UI episodes in SCI subjects compared to intravesical resiniferatoxin at 12 and 18 months after injections. A small crossover study found BTX-B significantly more effective than placebo in reducing weekly UI episodes in subjects with predominately idiopathic DO. Adverse events (AEs) in BTX-A-treated subjects included urinary tract infection, pain at the injection site, hematuria and autonomic dysreflexia. Four subjects treated with BTX-B reported autonomic AEs. Conclusions: BTX may improve UI for subjects with refractory DO. The preferred dose and type of BTX is not known. Long-term efficacy and safety remain unclear and require conduct of larger RCT using standardized and validated clinical outcomes measures.
Bibliographical noteFunding Information:
We acknowledge Indulis Rutks for his work on literature search and article retrieval. This project was supported by NIDDK R01 DK063300-01A2 the Department of Veterans Affairs Health Services Research and Development Service and the Minneapolis VA Center for Chro nic Disease Outcomes Research. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs. This project was supported by the NIDDK (R01 DK063300-01A2) and the Department of Veterans Affairs Health Services Research and Development Service, and the Minneapolis VA Center for Chronic Disease Outcomes Research.
Copyright 2008 Elsevier B.V., All rights reserved.
- Botulinum toxin
- Detrusor overactivity
- Spinal cord injury
- Systematic review
- Urinary incontinence