Sacral neuromodulation or Botox: are they effective in urge urinary incontinence

This study compared the effectiveness of sacral modulation and onabotulinumtoxinA on urge incontinence in women. The study concluded that both treatments were effective.

Urge incontinence (a sudden urge to urinate that can lead to urine leakage) can have a very negative impact on quality of life. While patients can be treated with medication or behavioral therapies, these may not remain effective over time. More invasive treatments may be needed.

Sacral modulation (SNM) involves the implantation of a device near the sacral nerve in the spine. This device sends electrical impulses to the muscles of the bladder. OnabotulinumtoxinA (Botox, or BTX) involves an injection that paralyzes the bladder muscle. It is not clear which treatment is safer and more effective in women with urge incontinence.

This study included 386 women with urge incontinence who did not respond to pelvic floor (Kegel) exercises or at least 2 drug treatments. The women were randomly assigned to undergo SNM or injection of BTX. Participants were followed for up to 2 years.

Over 2 years, 72% of the BTX group had a second injection and 48% had a third injection. Of the SNM tested participants, 58% of the group had their devices reprogrammed and 8.6% had their devices removed during the 2-year period.

Overall, both treatments showed a 50% or more decrease in incontinence episodes, starting from device implantation or 1 month after BTX injection. BTX treatment did have higher patient satisfaction and endorsement.

24% of BTX patients experienced recurrent urinary tract infections, compared to 10% of SNM patients.

This study concluded that both treatments showed a similar quality of life improvement at the trial end. BTX treatment was associated with higher patient satisfaction and endorsement but also increased UTI rates. 

5% of each SNM and BTX treatment group did request to move to the other treatment. This might suggest that the treatments effectiveness depends on each patient. Due to SNM and BTX having similar results in UUI treatment overall, the authors highlighted that costs of SNM and BTX treatments must be considered when deciding between them.