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[Botulinum toxin injection for refractory non-neurogenic overactive bladder. Systematic review]
Revue Medicale De Bruxelles
|April 11, 2015
Summary
Botulinum toxin injections effectively treat refractory overactive bladder (OAB) by reducing symptoms and improving quality of life. While generally safe, potential side effects like incomplete bladder emptying require patient counseling.
Area of Science:
- Urology
- Pharmacology
Background:
- Overactive bladder (OAB) significantly impacts quality of life, with first-line treatments showing limited efficacy in about 50% of patients.
- Botulinum toxin, used for neurogenic OAB, is being evaluated for refractory idiopathic OAB.
Purpose of the Study:
- To review literature on the efficacy and safety of intradetrusor botulinum toxin injections for refractory idiopathic overactive bladder.
Main Methods:
- Systematic literature review of articles published between May 1988 and April 2013 in Medline.
- Included 37 studies, comprising 8 randomized controlled trials against placebo.
Main Results:
- Intradetrusor botulinum toxin injections reduce urinary frequency, urgency, nocturia, and incontinence episodes, while improving bladder capacity and quality of life.
- Common side effects include incomplete bladder emptying and increased UTI risk; 100-150 U onabotulinumtoxinA offers the best efficacy-tolerance balance.
- Effects last 3-12 months, with repeated injections maintaining efficacy; trigone injections do not cause vesicoureteral reflux.
Conclusions:
- Intradetrusor botulinum toxin is an effective second-line therapy for refractory non-neurogenic overactive bladder.
- Patients must be informed about intermittent catheterization risks.
- Long-term effectiveness and urothelium effects require further investigation.
