title: Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA).
abstract: BACKGROUND
  The use of botulinum toxin A (BoNTA) in the treatment of lower urinary tract dysfunction has expanded in recent years and the off-licence usage list includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD). There are two commonly used preparations of BoNTA: Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA).
  
  
  OBJECTIVE
  To compare the reported outcomes of onabotulinumtoxinA and abobotulinumtoxinA in the treatment of NDO, IDO, PBS, DSD, and BOO for adults and children.
  
  
  METHODS
  We performed a systematic review of the published literature on PubMed, Scopus, and Embase in the English language reporting on outcomes of both BoNTA preparations. Review articles and series with <10 cases were excluded. The articles were graded for level of evidence and conclusions drawn separately for data with higher-level evidence.
  
  
  RESULTS
  There is high-level evidence for the use of onabotulinumtoxinA and abobotulinumtoxinA in adults with NDO but only for abobotulinumtoxinA in children with NDO. Only onabotulinumtoxinA has level 1 evidence supporting its use in IDO, BOO, DSD, and PBS/interstitial cystitis.
  
  
  CONCLUSIONS
  We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used.
authors.affiliation: Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. mangeraaltaf@hotmail.com
authors.forename: Altaf
authors.initials: A
authors.lastname: Mangera
authors.forename: Karl-Erik
authors.initials: KE
authors.lastname: Andersson
authors.forename: Apostolos
authors.initials: A
authors.lastname: Apostolidis
authors.forename: Chris
authors.initials: C
authors.lastname: Chapple
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Antonella
authors.initials: A
authors.lastname: Giannantoni
authors.forename: Stavros
authors.initials: S
authors.lastname: Gravas
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy; D008297:Male; D009498:Neurotoxins / Q000627:therapeutic use*; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000188:drug therapy*
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA