Comparison of Short Term Outcomes of Sacral Nerve Stimulation and Intradetrusor Injection of OnabotulinumtoxinA (Botox) in Women With Refractory Overactive Bladder.
OBJECTIVE
The aim of the study was to compare the short-term outcomes of sacral nerve stimulation (SNS) and intradetrusor injection of OnabotulinumtoxinA (Botox) for overactive bladder (OAB) symptoms refractory to behavioral modifications and pharmacologic therapy.


METHODS
This is a retrospective cohort study evaluating the outcomes of SNS and Botox procedures that were performed for refractory OAB symptoms at a tertiary care referral center. The primary outcome was "failure" of treatment that was defined as less than 50% improvement from the baseline symptoms at 6 months.


RESULTS
Sixty-five SNS and 63 Botox procedures met the inclusion criteria. Women undergoing Botox were more likely to report failure 6 months after the intervention as compared with those undergoing SNS (20 [31.8%] vs 7 [10.8%], P = 0.003; unadjusted odds ratio = 3.85, confidence interval = 1.5-9.93; adjusted odds ratio = 4.47, confidence interval = 1.69-14.4). However, there was no difference in the proportion of women who were started on antimuscarinic medications for persistent urgency urinary incontinence after both procedures (12 [18.5%] women in SNS group and 17 [27%] women in the Botox group, P = 0.249). The most common complication of the SNS procedure was wound related (8 [12.3%]), whereas the most common complication of the Botox procedure was urinary tract infection (31 [49.2%]).


CONCLUSIONS
The SNS resulted in lower failure rates at 6 months when performed for refractory OAB symptoms as compared with the Botox procedure. However, further studies are needed to evaluate the long-term cost-effectiveness of both procedures.
From the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
Ruchira
R
Singh
Sherif A
SA
El Nashar
Emanuel C
EC
Trabuco
Christopher J
CJ
Klingele
John B
JB
Gebhart
John A
JA
Occhino
D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D004599:Electric Stimulation Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009130:Muscle, Smooth; D012189:Retrospective Studies; D012445:Sacrococcygeal Region / Q000294:innervation; D017211:Treatment Failure; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000628:therapy*
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A