Botulinum toxin treatment for overactive bladder and detrusor overactivity in adults

To review the evidence in support of botulinum toxin (BoNT-A) for overactive bladder and detrusor overactivity in adults.

A search of Medline and Pubmed was undertaken using the search terms 'botulinum toxin' with 'overactive bladder', 'detrusor overactivity', 'randomised trial' and 'trial'. A narrative review was undertaken based on the papers identified.

Only four randomised trials reporting the effects of botulinum toxin in this group of patients exist, alongside three systematic reviews and numerous uncontrolled series. Overall, BoNT-A appears an effective treatment modality, with significant and clinically meaningful reductions in urinary symptoms. Urgency and urgency incontinence episodes appear more responsive than absolute frequency. The side effect profile can be predicted from the mode of action of BoNT-A and includes voiding difficulty and urinary tract infection. Few data exist comparing the efficacy and safety of different doses, nor directly comparing the two common preparations, onabotulintum toxin A with apobotulinum toxin A. The cost-effectiveness of BoNT-A remains to be fully evaluated.

BoNT-A is an emerging treatment for overactive bladder and detrusor overactivity. The data available to date are of moderate quality with few large randomised trials. However, the drug appears to be effective and safe, although further work is required to identify the most cost-effective dose and treatment interval for maximum benefit.