What Is the Role of Additional Pharmacotherapy and Neuromodulation in Patients with Marginal Benefit from Botulinum Toxin Injection?

• Published in: Current urology reports Vol. 19; no. 11; p. 91
• Main Authors: Zahner, Patricia M., Giusto, Laura L., Goldman, Howard B.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2018
• Subjects: Acetylcholine Release Inhibitors - administration & dosage; Botulinum Toxins, Type A - administration & dosage; Combined Modality Therapy; Electric Stimulation Therapy; Humans; Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu; Lumbosacral Plexus; Medicine; Medicine & Public Health; Nephrology; Section Editor; Tibial Nerve; Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction; Urinary Bladder, Neurogenic - drug therapy; Urinary Bladder, Neurogenic - therapy; Urinary Bladder, Overactive - drug therapy; Urinary Bladder, Overactive - therapy; Urology; OnabotulinumtoxinA; Anticholinergics; Overactive bladder; Sacral neuromodulation; Neurogenic bladder
• ISSN: 1527-2737; 1534-6285
• DOI: 10.1007/s11934-018-0842-8

Purpose of Review
Third-line therapies for patients with overactive bladder (OAB) can improve symptoms for those who have failed conservative therapies. Options include percutaneous tibial nerve stimulation (PTNS), cystoscopic injection of onabotulinumtoxinA (BTX-A), and sacral neuromodulation (SNM). This paper aims to review the current literature on the treatment of patients with idiopathic OAB who have undergone BTX-A injections and have not responded or have undesirable side effects from the therapy.
Recent Findings
There are no randomized control trials examining the role of concurrent medical therapy and BTX-A; rather, there are observational studies in the neurogenic population. Furthermore, there are two observational studies on the role of SNM in BTX-A refractory idiopathic OAB patients demonstrating its safety and efficacy.
Summary
There are many options available to the patient who fails BTX-A. Further research in this specific patient population is necessary to determine why patients have suboptimal responses and to delineate the next step in treatment.