What type of study is this?

This is a Systematic Review study (also classified as: Meta-Analysis).

September 28, 2025Open Access

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

Key Points

BoNT-A significantly reduced urgency urinary incontinence episodes compared to both placebo and SNM.
Data from 12 studies with 2645 patients revealed an odds ratio demonstrating BoNT-A's effectiveness over placebo.
Follow-up results at 3 and 6 months showed BoNT-A provided a higher rate of complete resolution of UUI than placebo.
Careful patient selection is essential due to BoNT-A's higher risk of urinary tract infections than both comparators.

Abstract

Background: Refractory overactive bladder (OAB) poses a significant clinical burden, often severely impacting quality of life (QoL). While intradetrusor onabotulinumtoxinA (BoNT-A) and sacral neuromodulation (SNM) are established therapeutic options, a direct comparison of their efficacy and safety profiles is essential to guide clinical decision-making. This study compares BoNT-A against placebo and SNM for the management of refractory OAB in women. Methods: Following PRISMA guidelines, PubMed, Scopus, CENTRAL, and Google Scholar were searched until February 2025 for randomized controlled trials (RCTs) and cohort studies on treatment alternatives for refractory OAB. Treatment outcomes at 3- (BoNT-A vs. placebo) and 6-month (BoNT-A vs. SNM) follow-up were analyzed. Odds ratios (ORs) and mean differences (MDs) were calculated for dichotomous and continuous variables, respectively, with heterogeneity assessed via I2 test. Study quality was evaluated using CASP tools. Results: Pooled data from 12 studies (2645 patients) indicated that BoNT-A significantly reduced urgency urinary incontinence (UUI) episodes compared to placebo (p = 0.02) and SNM (p = 0.0008). Additionally, a ≥75% reduction in UUI episodes was more likely with BoNT-A compared to both placebo (p < 0.00001) and SNM (p < 0.00001). Complete resolution of UUI was more likely with BoNT-A compared to placebo (p < 0.00001); however, when compared to SNM, the latter demonstrated a higher rate of complete UUI resolution (p < 0.00001). Patient-reported QoL did not show significant differences between BoNT-A and SNM (p = 0.2). Urinary tract infection (UTI) risk was higher with BoNT-A than both comparators. Conclusions: While BoNT-A offers robust symptom control, its safety profile necessitates careful patient selection. SNM remains a viable alternative for those prioritizing fewer adverse events. The study highlights the need for standardized outcome reporting, long-term cost-effectiveness analyses, and personalized treatment approaches.

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Cite This Study

Rada et al. (Fri,) studied this question.

synapsesocial.com/papers/68d9052941e1c178a14f57d5 https://doi.org/https://doi.org/10.3390/toxins17100479

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