Comparing OnabotulinumtoxinA Injections and Sacral Neuromodulation for Treatment of Overactive Bladder
Daisy S. Chen, MS1, Esther L. Finney, MD2, Amanda L. Pomeroy, MS1, Shravya K. Sakunala, BS1, Arthur P. Mourtzinos, MD2, Lara S. MacLachlan, MD2.
1Tufts University School of Medicine, Boston, MA, USA, 2Lahey Hospital and Medical Center Department of Urology, Burlington, MA, USA.
BACKGROUND: After failing more conservative treatments, patients with overactive bladder seek third-line therapies for their urinary symptoms. Two such treatments are intradetrusor onabotulinumtoxinA injections and sacral neuromodulation. We compared the patient profiles and success rates of these two therapies to determine whether successful treatment correlated with certain types of patients. We also identified patients who received both types of treatment to assess for factors that may have affected treatment outcomes.
METHODS: We conducted a single-institution retrospective chart review of patients with overactive bladder who received either onabotulinumtoxinA injection, sacral neuromodulation, or both from 2005 to 2021. We compared age, sex, type of diagnosis, and success rates based on initial treatment modality. Success was defined as patient satisfaction with onabotulinumtoxinA injection and successful second-stage implantation for sacral neuromodulation. For patients who received both types of treatment, we investigated reasons for failing the first treatment and success rate of the second treatment.
RESULTS: For initial therapy, 249 patients had onabotulinumtoxinA injections and 202 patients had sacral neuromodulation. Patients who received onabotulinumtoxinA injections were more likely to be older (70.2 vs 67.1 years, p=0.02) and female (74% vs 70%, p=0.02) than those who received sacral neuromodulation as initial therapy. Urge incontinence was the most common diagnosis (56.8%). There was no significant difference between the proportions of urge incontinence diagnosis in the onabotulinumtoxinA and sacral neuromodulation groups. The overall success rate for both treatments was 78.9%. There was no significant difference between the success rates of the two groups. Finally, there were 14 patients who received both therapies. Four patients received onabotulinumtoxinA first, and 10 patients received sacral neuromodulation first. Reasons for crossover included limited effectiveness, short-lived effects of onabotulinumtoxinA, and side effects of lower extremity muscle twitching with sacral neuromodulation.
CONCLUSIONS: Older female patients were more likely to have onabotulinumtoxinA as initial treatment. Success rates for onabotulinumtoxinA and sacral neuromodulation were similar, and there was no difference in patient diagnosis. The majority of patients who tried both treatments had success with the second treatment modality, which reflects the need for an individualized approach to treatment of overactive bladder.
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