title: Efficacy and safety of onabotulinumtoxinA in treating neurogenic detrusor overactivity: a systematic review and meta-analysis.
abstract: BACKGROUND
  OnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO.
  
  
  METHODS
  We searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated.
  
  
  RESULTS
  Four publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = -10.91, 95% confidence intervals [CIs] = -14.18--7.63, P < 0.0001); maximum cystometric capacity (SMD = 146.09, 95% CI = 126.19-165.99, P < 0.0001) and maximum detrusor pressure (SMD = -32.65, 95% CI = -37.83--27.48, P < 0.0001) indicated that onabotulinumtoxinA was more effective than the placebo, despite the doses of onabotulinumtoxinA. Safety assessments primarily localized to the urinary tract indicated onabotulinumtoxinA were often associated with more complications. Urinary tract infections (relative risk [RR] =1.48, 95% CI = 1.20-1.81, P = 0.0002); hematuria (RR = 1.81, 95% CI = 1.00-3.24, P = 0.05) and urinary retention (RR = 5.87, 95% CI = 3.61-9.56, P < 0.0001).
  
  
  CONCLUSIONS
  This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.forename: Hui-Lei
authors.initials: HL
authors.lastname: Yan
authors.forename: Yuan-Shan
authors.initials: YS
authors.lastname: Cui
authors.forename: Huan-Tao
authors.initials: HT
authors.lastname: Zong
authors.affiliation: Department of Urology, Beijing Tian Tan Hospital, Capital Medical University; Neurourology Research Division, China National Clinical Research Center for Neurological Disease, Beijing 100050, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D019274:Botulinum Toxins, Type A / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D019274:Botulinum Toxins, Type A
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