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

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.

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. 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.

Current urology reports. 2018 Sep 08*** epublish ***

Patricia M Zahner, Laura L Giusto, Howard B Goldman

Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA. ., Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA.

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