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.
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.
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%]).
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.
Female pelvic medicine & reconstructive surgery. 0000 [Epub]
Ruchira Singh, Sherif A El Nashar, Emanuel C Trabuco, Christopher J Klingele, John B Gebhart, John A Occhino
From the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.