title: OnabotulinumtoxinA for neurogenic detrusor overactivity and dose differences: a systematic review.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of onabotulinumtoxinA for patients with neurogenic detrusor overactivity (NDO).
  
  
  METHODS
  We searched the Cochrane Library, PUBMED, EMBASE, Chinese Bio-medicine database, China Journal Full-text Database, VIP database, Wanfang database for randomized controlled trials (from inception to September 2012). Two authors independently selected studies, extracted data and assessed the methodological and evidence quality using the Cochrane Risk of Bias Table and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) respectively. Data analysis was performed by RevMan 5.1 and descriptive analysis was employed if necessary.
  
  
  RESULTS
  Eight studies were selected (n=1879 participants). OnabotulinumtoxinA was more related to urinary tract infection (UTI) (200 U: OR 1.72, CI: 1.18-2.52; 300 U: OR 1.88, CI: 1.31-2.69) versus placebo. Also, OnabotulinumtoxinA was superior to placebo in improving maximum cystometric capacity (MCC) (200 U: OR 138.80, CI: 112.45-165.15; 300 U: OR 152.09, CI: 125.25-178.93) and decreasing maximum detrusor pressure (MDP) (200 U: MD -29.61, CI: -36.52--22.69; 300 U: MD-28.92, CI: -39.59--18.25). However, there were no statistical differences between 200 U and 300 U onabotulinumtoxinA in UTI (OR 0.84, CI: 0.58-1.22), MCC (OR-12.72, CI: -43.36-17.92) and MDP (MD 2.21, CI: -6.80-11.22).
  
  
  CONCLUSIONS
  OnabotulinumtoxinA may provide superior clinical and urodynamic benefit for populations with NDO. High-quality studies are required for evaluating the optimal dose, long-term application and when to perform repeated injections.
authors.affiliation: The Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.|Liver Cancer Institute of Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhang
authors.affiliation: The Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.|Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yongteng
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Quanzhou Orthopedic-traumatologigal Hospital, Quanzhou 362000, China.
authors.forename: Shengping
authors.initials: S
authors.lastname: Yang
authors.affiliation: The Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.|The First Clinical Medicine College of Lanzhou University, Lanzhou, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liang
authors.affiliation: Department of Urology, Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
authors.forename: Yunxin
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: The Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.|Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.|Key Laboratory of Clinical Translational Research and Evidence-Based Medicine of Gansu Province, Lanzhou, China.
authors.forename: Yali
authors.initials: Y
authors.lastname: Liu
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D017594:Publication Bias; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D014563:Urodynamics / Q000187:drug effects; D055815:Young Adult
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A