Review
Spinal Cord (2007) 45, 535–541; doi:10.1038/sj.sc.3102070; published online 24 April 2007
Botulinum toxin for treatment of urinary incontinence due to detrusor overactivity: a systematic review of effectiveness and adverse effects
R MacDonald1, H A Fink1, C Huckabay2, M Monga2 and T J Wilt1
- 1Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research and the Cochrane Review Group in Prostate Diseases and Urologic Cancers (111-0), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN, USA
- 2Department of Urology, Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN, USA
Correspondence: TJ Wilt, Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research (111-0), 1 Veterans Drive, Minneapolis, MN 55417, USA
Abstract
Study design:
Systematic review.
Objective:
To evaluate effectiveness and adverse effects of botulinum toxin (BTX) for treatment of urinary incontinence (UI) due to detrusor overactivity (DO).
Methods:
Randomized controlled trials published in English before November 2006 were included if they enrolled subjects with UI caused by DO and reported incontinence outcomes.
Results:
Three trials totaling 104 subjects with DO refractory to antimuscarinic treatment were included. Two BTX-A trials enrolled primarily patients with NDO secondary to spinal cord injury (SCI) (93%). BTX-A decreased daily UI episodes compared to placebo but the reductions were only significantly different at a few of the time intervals during 24 weeks of follow-up. BTX-A was superior in reducing daily UI episodes in SCI subjects compared to intravesical resiniferatoxin at 12 and 18 months after injections. A small crossover study found BTX-B significantly more effective than placebo in reducing weekly UI episodes in subjects with predominately idiopathic DO. Adverse events (AEs) in BTX-A-treated subjects included urinary tract infection, pain at the injection site, hematuria and autonomic dysreflexia. Four subjects treated with BTX-B reported autonomic AEs.
Conclusions:
BTX may improve UI for subjects with refractory DO. The preferred dose and type of BTX is not known. Long-term efficacy and safety remain unclear and require conduct of larger RCT using standardized and validated clinical outcomes measures.
Keywords:
botulinum toxin, urinary incontinence, detrusor overactivity, spinal cord injury, systematic review
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