Botulinum neurotoxin A for overactive bladder treatment: advantages and pitfalls

Overactive bladder (OAB) syndrome is a special condition characterized by urgency, with or without urinary urge incontinence (UUI), associated to frequency and nocturia, with important consequences on patients' quality of life (QoL). Administered as intradetrusor injections, botulinum neurotoxin type A (BoNT/A) is a new, promising, minimally invasive treatment option for OAB patients, non-compliant to conventional antimuscarinics. The aim of our study was to perform a systematic review of the literature concerning the efficiency and safety of different BoNT/A products in the treatment of OAB.

A thorough PubMed search was performed. After having applied strict inclusion criteria, relevant articles were selected for review. Priority was given to large, multicenter, placebo-controlled trials and systematic reviews.

Most of the eligible studies were centered around onabotulinumtoxin A (Botox), with treatment doses ranging from 50 U to 300 U. An increased efficiency of onabotulinumtoxin A was found for both OAB types, clinically resulting in a significant decrease in UUI episodes, improved urodynamic parameters and patient QoL. The most common adverse events were urinary tract infections and an increased post-void residue, with the necessity for clean intermittent self catheterization. Abobotulinumtoxin A (Dysport) obtained similar results, but with a much smaller number of trials available to date.

Onabotulinumtoxin A is a promising, efficient, minimally invasive approach to OAB patients with official recommendations for both OAB types, offering large perspectives in daily urological practice. Abobotulinumtoxin A revealed similar results to onabotulinumtoxin A, making it a valid therapeutic alternative.