Comparison of Different Treatment Outcomes for Refractory Overactive Bladder: A Systematic Review and Meta-Analysis.

Area of Science:

• Urology
• Pharmacology
• Clinical Trials

Background:

• Refractory overactive bladder (OAB) significantly impacts quality of life.
• OnabotulinumtoxinA (BoNT-A) and sacral neuromodulation (SNM) are key treatments for refractory OAB.
• Direct comparison of BoNT-A and SNM efficacy and safety is crucial for clinical guidance.

Purpose of the Study:

• To compare the efficacy and safety of onabotulinumtoxinA (BoNT-A) versus placebo and sacral neuromodulation (SNM) for refractory overactive bladder (OAB).
• To guide clinical decision-making in managing refractory OAB in women.

Main Methods:

• Systematic review and meta-analysis following PRISMA guidelines.
• Inclusion of randomized controlled trials and cohort studies up to February 2025.
• Analysis of treatment outcomes at 3- and 6-month follow-up, assessing urgency urinary incontinence (UUI) episodes and quality of life (QoL).

Main Results:

• BoNT-A significantly reduced urgency urinary incontinence (UUI) episodes compared to placebo and SNM (p < 0.02).
• Higher rates of complete UUI resolution were observed with BoNT-A versus placebo, but SNM showed higher complete resolution rates than BoNT-A (p < 0.00001).
• Increased risk of urinary tract infection (UTI) was associated with BoNT-A; no significant QoL differences were found between BoNT-A and SNM.

Conclusions:

• BoNT-A provides strong symptom control for refractory OAB but carries a higher UTI risk.
• SNM is a viable alternative, particularly for patients prioritizing fewer adverse events.
• Further research should focus on standardized reporting, cost-effectiveness, and personalized treatment strategies for refractory OAB.