Midurethral Sling vs OnabotulinumtoxinA in Females With Urinary Incontinence: The MUSA Randomized Clinical Trial

Area of Science:

• Urology
• Gynecology
• Female Pelvic Medicine

Background:

• Mixed urinary incontinence (MUI) significantly impacts quality of life and presents management challenges.
• Limited comparative studies exist for procedural treatments of MUI.

Purpose of the Study:

• To compare the efficacy of intradetrusor onabotulinumtoxinA versus midurethral sling for treating moderate to severe MUI in females.
• To evaluate which treatment offers superior improvement in MUI symptoms.

Main Methods:

• A randomized superiority trial involving 150 females (≥21 years) with bothersome MUI unresponsive to conservative treatments.
• Participants received either onabotulinumtoxinA injections or a synthetic mesh midurethral sling.
• The primary outcome was the change in Urogenital Distress Inventory (UDI) total score at 6 months.

Main Results:

• No significant difference was observed in the primary outcome (UDI total score improvement) between the onabotulinumtoxinA and sling groups at 6 months.
• The midurethral sling group showed significantly greater improvement in the UDI stress subscore compared to the onabotulinumtoxinA group.
• No significant difference was found in the UDI irritative subscore between the groups. Adverse events were similar across both treatments.

Conclusions:

• Intradetrusor onabotulinumtoxinA and midurethral slings demonstrate comparable efficacy in improving overall mixed urinary incontinence symptoms at 6 months.
• Findings support shared decision-making between patients and clinicians for treatment selection based on symptom profiles and preferences.
• Further research may explore long-term outcomes and patient-reported satisfaction.