Systematic Review Of Botulinum Toxin A For Treatment Of Urinary Incontinence Due To Neurogenic Detrusor Overactivity

Objective：To evaluate the efficacy and safety of Botulinum toxin A for treatment of urinaryincontinence due to neurogenic detrusor overactivity(NDO) refractory to antimuscarictreatment.Methods：We searched Pubmed/Medline(1995-2012)、 Cochrane Library、 CBM (1995-2012)toidentify clinical trails involving BTX-A for treatment of urinary incontinence due toneurogenic detrusor overactivity refractory to antimuscaric treatment.We also checked thereferences in the reports of each included trial.The quality of randomized controlledtrials(RCTS) was accessed according to the methods recommended by The CochraneCollaboration.Two reviewers extracted data independently and data analyses were conductedwith The Cochrane Collaboration’s Revman5.1. Results：The final4RCTS totaling808subjects with NDO refractory to antimuscaric treatment wereincluded. The quality of4RCTs was grade A.Meta-analyses showed that comparableage,years since NDO onset,urinary incontinence(UI) episodes per day,maximum cystometriccapicity(MCC),maximum detrusor pressure(MDP),and incontinence Quality of life atbaseline between the three groups(p>0.05),at week6,botulinum toxin A200u and300usignificantly reduced UI episodes per day ［WMD-1.75,95%CI(-2.60,-0.90)］,MCC［WMD152.35,95%CI(130.94,173.77)］、 MDP ［WMD-34.28,95%CI(-40.03,-28.54)］,I-QOL［WMD17.85,95%CI(14.32,21.38)］.However,adverse eventsof urinary tract infection and urinary retention were significantly more than those of theplacebo group.Conclusions：Botulinum toxin A significantly reduced UI and improved urodynamics and I-QOL withNDO refractory to antimuscaric treatment.Both doses were well tolerated with no clinicallyrelevant difference in efficacy and safety between two doses.