In a nutshell
This paper reviewed the outcomes of patients with non-responsive overactive bladder (OAB) who were treated with sacral neuromodulation (SNM) after onabotulinumtoxinA (BTX, Botox) therapy. The main finding was SNM may be successful for treating non-responsive OAB.
Some background
OAB is characterized by having a strong urge to urinate and being woken up at night due to the need to urinate (nocturia). Behavioral training such as pelvic floor exercises and bladder training may be used to treat OAB. Medications such as anticholinergics and antimuscarinics may also be used as a treatment. If these treatments fail, SNM and BTX therapy may be considered.
BTX treatment involves small injections of BTX into the bladder. This has been shown to improve OAB in some cases. However it is not effective for all and has been associated with urinary tract infections. SNM involves stimulating the sacral nerves (nerves around the bladder and pelvic floor) with electrodes. This has been shown to reduce incontinence (involuntary leakage of urine) and increase bladder capacity. The effects of SNM following non-response to BTX in patients with OAB are still not clear.
Methods & findings
This article analyzed 7 other studies investigating the effects of SNM therapy after non-response to BTX therapy. Overall, 319 patients were included.
58.5% of patients had successful treatment with SNM after previously not responding to BTX treatment. There was no difference in effects in those that received SNM after non-response to BTX or in those that received SNM as the first treatment.
The bottom line
The authors suggest that SNM may be an effective treatment for OAB following non-response to BTX or as a first treatment.
The fine print
Only 7 studies were included in this paper. The study with the largest sample size only included 67 patients. Therefore, these results may not represent a larger patient population.
What’s next?
If you have questions about the treatment of OAB, please consult your doctor.
Published By :
PLOS ONE
Date :
Apr 01, 2020
