A comparative study between sacral neuromodulation and intravesical botulinum toxin injection for patients with refractory overactive bladder

Issam S. Al-Azzawi,Haider T. Al-Hindawi

doi:10.1080/2090598x.2020.1740391

Issam S. Al-Azzawi, Haider T. Al-Hindawi

Open Access

https://doi.org/10.1080/2090598x.2020.1740391

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Abstract

ABSTRACT Objective To compare the efficacy, safety, patient compliance and quality of life (QoL) (early and at 6 months after treatment), in a group of Iraqi female patients with refractory overactive bladder (OAB), treated with intradetrusor botulinum toxin A (BTX) injections vs sacral neuromodulation (SNM). Patients and methods A prospective, clinical interventional study of 37 female patients assessed by history, physical examination, voiding diary, ultrasonography (US), and urodynamics. The patients were assigned to one of two groups: Group 1, treated with cystoscopic BTX injections; and Group 2, treated with SNM. Response to treatment was assessed by voiding diary, the Treatment Benefit Scale, a modified Quality of Life scale, urine culture, and abdominal US. Results The mean age of the patients in Group 1 (BTX) was 43.8 years and in Group 2 (SNM) was 37.2 years. OAB-wet was diagnosed in 11 patients in Group 1 and 10 in Group 2. At the 6-month follow-up there were 14/16 and 12/15 positive responders, in groups 1 and 2, respectively; with no major complications. All the responders had a significant improvement in their overall QoL after both types of treatment. Conclusions Both BTX and SNM, in our experience, were safe and effective in managing our patients with refractory OAB after 6 months of follow-up, which was also reflected by an improvement in their QoL. Abbreviations BTX: botulinum toxin A; IPG: implantable pulse generator; OAB: overactive bladder; PVR: post-void residual urine; QoL: quality of life; SNM: sacral neuromodulation; UDS, urodynamics; UI, urinary incontinence

Highlights

Treatment of patients with overactive bladder (OAB) may require different lines and approaches; starting with lifestyle modifications, pelvic floor muscle training, bladder re-training and medications.When these therapies fail or are intolerable for patients, other options are currently available, e.g. sacral neuromodulation (SNM), percutaneous tibial nerve stimulation and botulinum toxin A (BTX) injections, which should be considered before more invasive options, such as bladder augmentation or urinary diversion [1,2,3,4]
OAB is not a life-threatening condition, but it can have a profound effect on quality of life (QoL), which is why in choosing a treatment its potential benefit must be weighed against its risk of adverse events
Inclusion criteria were: female patients aged >18 years, who presented with long-standing OAB symptoms; refractory to first-line treatments and antimuscarinic drugs

Summary

Introduction

Treatment of patients with overactive bladder (OAB) may require different lines and approaches; starting with lifestyle modifications, pelvic floor muscle training, bladder re-training and medications (antimuscarinics and β-agonists).When these therapies fail or are intolerable for patients, other options are currently available, e.g. sacral neuromodulation (SNM), percutaneous tibial nerve stimulation and botulinum toxin A (BTX) injections, which should be considered before more invasive options, such as bladder augmentation or urinary diversion [1,2,3,4]OAB is not a life-threatening condition, but it can have a profound effect on quality of life (QoL), which is why in choosing a treatment its potential benefit must be weighed against its risk of adverse events. Patients with OAB are significantly burdened by their symptoms, and further burdened when seeking treatment relief of their symptoms that can be costly and time consuming. These burdens significantly lower QoL scores in such patients and for many it leaves them socially isolated and psychologically disturbed [5,6]. In Iraq, OAB is underestimated, as many patients do not consult doctors because of embarrassment, and some patients even believe that these symptoms are natural and due to ageing. The unavailability of second- or third-line treatment options in Iraq was an important factor contributing to frustration of both patients and their doctors

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