Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder.
OBJECTIVE
Overactive bladder (OAB) is a pathology impairing patients' quality of life and with a high percentage of patients who are refractory to medication. In this paper, technical opinion of an «expert panel» is assessed in order to gain the most reliable professional consensus on scientific evidence available on the criteria of use of Onabotulinumtoxin A (OnabotA) in OAB.


METHODS
according to DELPHI method, 42 panelists answered a survey of 93 items divided into four strategic areas including clinical criteria and recommendations in order to improve, at different levels, the current approach to patients with OAB. The recent advances in the field, areas of controversy and their real application possibilities in the different areas of our health care system were taken into consideration.


RESULTS
Two rounds of the questionnaire were completed by all experts. In the first round, a criteria consensus was reached for 64 of 93 (68.8%) questions analyzed; in the second round the consensus reached was for 83 items evaluated (89.25%). An agreement among panelist was reached for: 1) definition, classification, detection and differential diagnosis; 2) medical treatment; 3) surgical treatment; 4) role of OnabotA in the treatment of OAB.


CONCLUSIONS
the consensus is broadly in line with the latest scientific evidence on OAB. The panelists believe that it is necessary to propose a change in the current definition of OAB and that it seems necessary to improve the screening tools too. Medical treatment of OAB must be tailored to each patient, staged and progressive. The use of OnabotA (Botox(®)) could imply therapeutic advantages with respect to other treatments, and positions itself as a safe and effective alternative to treat drug refractory OAB.
Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, España. Electronic address: ESTEBOTE@telefonica.net.
M
M
Esteban
Servicio de Urología, Hospital Clínico San Carlos, Universidad Complutense, Madrid, España.
J
J
Salinas
Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España.
S
S
Arlandis
Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, España.
J
J
Díez
Servicio de Urología, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, España.
M
M
Jiménez
Servicio de Urología, Hospital Son Llàtzer, Palma de Mallorca, España.
M
M
Rebassa
Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, España.
J C
JC
Angulo
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D011795:Surveys and Questionnaires; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
D019274:Botulinum Toxins, Type A
Delphi method; Diagnosis; Diagnóstico; Método Delphi; Onabotulinumtoxin A; Overactive bladder; Tratamiento; Treatment; Vejiga hiperactiva