Botulinum toxin A in idiopathic overactive bladder: a narrative review of 5410 cases
Abstract
INTRODUCTION
When conservative treatments fail, botulinum toxin A (BoNT-A) is an option for refractory idiopathic overactive bladder (OAB). This review evaluates the efficacy, safety, and predictive factors for BoNT-A in this situation.
MATERIALS AND METHODS
A literature search up to January 2025 was performed using PubMed, Google Scholar, and Embase to assess efficacy, safety, and predictors of adverse events (AE) related to BoNT-A. The risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized studies and the Critical Appraisal Skills Programme (CASP) checklist for cohort studies. The quality of the review was evaluated based on the Oxford criteria, following the Strengthening the Assessment of Narrative Review Articles (SANRA) guidelines, and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews.
RESULTS
31 studies were included, involving 5410 patients. BoNT-A improves OAB symptoms even after reinjections. Higher doses do not enhance efficacy but increase AE. AE includes high post-void residual (PVR), clean intermittent self-catheterization (CISC), and Urinary Tract Infection (UTI). Predictors of CISC include age, male gender, hysterectomy, ≥3 vaginal deliveries, mixed incontinence, prior mid-urethral sling (MUS), high PVR, low Pressure at Pdet at First Micturition (PIP1) in women, low Bladder Compliance Index (BCI) in men, and high Bladder Outlet Obstruction Index (BOOI). Diabetes and…
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