Botulinum vs Sacral Neuromodulation for Urinary Incontinence
Compared with sacral neuromodulation, onabotulinumtoxinA resulted in a small improvement.
(HealthDay News) -- For women with refractory urgency urinary incontinence, onabotulinumtoxinA injections may help control leakage better than the implanted nerve stimulation device InterStim, according to a study published in the Journal of the American Medical Association.
Cindy Amundsen, MD, a professor of obstetrics and gynecology at Duke University in Durham, NC, and colleagues randomly assigned 364 women to either onabotulinumtoxinA injection or InterStim. The women had to have had at least 6 urgency incontinent episodes over 3 consecutive days. The participants were followed for 6 months.
Among women who kept track of their incontinence for at least 4 months, far more women who received onabotulinumtoxinA reported a 75 to 100% reduction in urgency incontinence symptoms compared to those using InterStim, the researchers found. Women given onabotulinumtoxinA had a greater risk of urinary tract infections, compared to women with the implant -- 35 versus 11%. Also, more onabotulinumtoxinA patients needed to use a catheter to relieve urinary retention. The most common side effect for women given the implant was the need to remove or reinsert it, which occurred in just 3% of the women.
"Among women with refractory urgency urinary incontinence, treatment with onabotulinumtoxinA compared with sacral neuromodulation resulted in a small daily improvement in episodes that although statistically significant is of uncertain clinical importance," the authors write. "In addition, it resulted in a higher risk of urinary tract infections and need for transient self-catheterizations."
Two authors disclosed financial ties to pharmaceutical and medical device companies, including Allergan, the manufacturer of BOTOX Cosmetic.
1. Amundsen CL, Richter HE, Menefee SA, et al. OnabotulinumtoxinA vs Sacral Neuromodulation on Refractory Urgency Urinary Incontinence in Women. JAMA. 2016;316(13):1366-1374. doi:10.1001/jama.2016.14617.