Comparing the effectiveness of sacral neuromodulation and onabotulinumtoxinA for overactive bladder

This study reviewed the outcomes of onabotulinumtoxinA (BTX) and sacral neuromodulation (SNM) in the treatment of overactive bladder (OAB). Researchers suggested that both treatments improved the outcomes of these patients, but BTX may be associated with more complications.

OAB of an uncontrolled need to urinate during the day and night. In some people, it leads to leakage of urine. This condition is present in around 23% of the US population, with women reporting twice as much as men. It affects the quality of life in over 15% of men and women.

First-line treatments consist of behavioral therapies such as urine bladder training or weight loss. Medication such as anticholinergics should be given after failed first-line treatment. However, at the expense of increased negative side effects.

BTX and SNM are third-line therapies for when conventional treatments fail to control symptoms. The use of these two treatment methods has already reduced the need for invasive surgeries. BTX is delivered as a bladder injection. It reduces muscle activity, improving disorders such as muscle spasticity (stiffness). However, BTX effects are of limited duration and it needs to be repeated every year. SNM uses an implanted small device to send electrical impulses to the bladder nerves. These impulses improve the action of these nerves in controlling the bladder activity, which may last 4 to 6 years.

Prior studies comparing the effectiveness of these two methods have contradictory results. Therefore, it is still not known which of these two treatment options is more suitable in patients with OAB.

This report reviewed 6 other studies with information about 2629 patients. 1295 received BTX treatment and 1334 received SNM. Patients were followed up for 6 to 36 months.

No significant differences in effectiveness were found between both methods after 6 months. Patients who received BTX were 1.55 times more of having a negative side effect. At the early stage, patients who received BTX were also 1.58 times more at risk of having urinary infection. However, this difference was not significant at 7 to 12 months of treatment. The short-term cost of BTX was significantly lower than that of the SNM method.

This study concluded that sacral neuromodulation and onabotulinumtoxianA had similar effectiveness in OAB. However, because of a lower risk of complications, the authors suggest that SNM might be a better treatment option.

Most of the studies included in this analysis were based on medical records. Also, the protocols used in different studies were very different. This might influence the outcomes. Further large controllers studies are needed.