Sacral neuromodulation improves clinical outcomes in patients that failed first-line Botulinum toxin treatment for overactive bladder

This study investigated the effectiveness of sacral neuromodulation (SNM) in patients with overactive bladder (OAB) that failed previous Botulinum toxin A (Botox; BTA) treatment. Researchers suggested that SNM is a good method in patients who failed first-line treatment.

OAB causes a sudden urge to urinate that is difficult to control. Patients need to urinate several times during the day and night. Leakage of urine might also be present, affecting the quality of life of these patients. This disorder is present in 11.8% to 16.6% of people from Europe and the US.  

The current standard treatment is behavioral therapy including bladder and pelvic muscle training with urine management. However, these treatments often fail due to an unsatisfactory response. In these cases, a new treatment such as Botulinum toxin A injections or SNM needs to be considered.

BTA injections into the bladder muscle improve the bladder movements that cause the OAB symptoms. When this treatment fails, it is recommended to switch to another line of treatment. The choice of treatment is made by the patient and the doctors.  

Another treatment option for OAB is SNM. During SNM a small electrode is placed near the sacral nerve (in the pelvis, controls bladder function). Electric impulses are sent to the nerve improving urinary function. Prior studies showed that this treatment significantly improved urinary symptoms. However, the effects of SNM in patients who underwent previous BTA injections are still not clear.

This study included information about 263 patients with OAB. All patients received SNM treatment. Of these, 75 patients previously received BTA injections (group 1) and the rest did not have previous BTA treatment (group 2). Patients were followed up for an average of 40.7 months.

The success rate for SNM in group 1 was 66.7% and in group 2 was 72.9%. In group 1, the success rate after 2 injections or less was 68.5% and for 3 injections or more was 61.1%.

This study concluded that SNM is a good treatment method for patients with OAB bladder who failed prior BTA treatment.

This study was based on medical records. Some information might have been incomplete. This might affect the results.