Effects of onabotulinumtoxina injection: A Synthesis of Findings from 28 Studies

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Original Abstract of the Article

Major Research Findings

OnabotulinumtoxinA has been shown to be an effective and well-tolerated treatment for refractory overactive bladder in real-world practice. 12 OnabotulinumtoxinA was also found to be an effective and well-tolerated treatment for overactive bladder (OAB) with urinary incontinence (UI) in randomized clinical trials. 12 However, data on the use of onabotulinumtoxinA in everyday clinical practice is limited. 12 One known side effect of intravesical onabotulinumtoxinA injection for overactive bladder (OAB) is urinary retention requiring clean intermittent catheterization (CIC), which deters patients from choosing this therapy. 25 To improve the therapeutic effect of intravesical onabotulinumtoxinA injection in patients with refractory overactive bladder (OAB), adding an anticholinergic or beta-3 agonist may be beneficial. 2 OnabotulinumtoxinA injection also carries a risk of urinary tract infection (UTI), which may lead to multidrug resistant (MDR) UTI. 16 Furthermore, patients with diabetes mellitus (DM) treated with intravesical onabotulinumtoxinA injection for overactive bladder (OAB) may have increased urinary retention requiring clean intermittent catheterization (CIC). 6 OnabotulinumtoxinA has also been investigated for the treatment of neurogenic detrusor overactivity, and a systematic review and network meta-analysis found that it is a recommended non or minimally invasive treatment option. 5 Finally, an alternative injection paradigm targeting the lower bladder may reduce the need for CIC by maintaining upper bladder function. 3

Benefits and Risks

Benefit Summary

OnabotulinumtoxinA injections may be a suitable treatment option for refractory overactive bladder, potentially alleviating symptoms such as urinary incontinence, frequency, and nocturia. 12 OnabotulinumtoxinA has also been found to be an effective treatment for neurogenic overactive bladder. 19 Additionally, combining onabotulinumtoxinA with other medications may enhance its therapeutic effects. 2

Risk Summary

OnabotulinumtoxinA injections are associated with potential risks such as urinary retention, requiring clean intermittent catheterization (CIC). 25 Additionally, there is a risk of urinary tract infection (UTI), which may lead to multidrug resistant (MDR) UTI. 16 Furthermore, patients with diabetes mellitus (DM) may experience higher rates of urinary retention following onabotulinumtoxinA injections. 6 Finally, maintaining upper bladder function is essential to reduce the need for CIC after onabotulinumtoxinA injections. 3

Comparison Between Studies

Commonalities Between Studies

Multiple studies have demonstrated the effectiveness and safety of onabotulinumtoxinA injections for treating refractory overactive bladder. 12 28 However, they also highlight the potential risks associated with the injections, including urinary retention and urinary tract infections. 25 16

Differences Between Studies

Research has revealed variations in the effectiveness and risks associated with onabotulinumtoxinA injections. 25 3 For instance, the risk of urinary retention after onabotulinumtoxinA injections can differ significantly among patients. 6 Additionally, some studies suggest that combining onabotulinumtoxinA with other medications can enhance therapeutic effects. 2

Consistency and Inconsistencies in Results

Research consistently indicates that onabotulinumtoxinA injections can be an effective and safe treatment option for refractory overactive bladder. 12 However, it's important to acknowledge the potential risks associated with the injections, including urinary retention and urinary tract infections. 25 16 6 These risks can vary depending on individual patient factors.

Considerations for Applying Findings to Real-Life

OnabotulinumtoxinA injections are a potentially effective treatment option for refractory overactive bladder. 12 However, it's crucial to discuss the potential risks, including urinary retention and urinary tract infections, with patients. 25 16 It's particularly important to be mindful of the increased risk of urinary retention in patients with diabetes mellitus. 6 Furthermore, maintaining upper bladder function is essential to minimize the need for clean intermittent catheterization (CIC) after injections. 3

Limitations of Current Research

Further research is needed to fully understand the long-term effectiveness and safety of onabotulinumtoxinA injections. 12 Additionally, the effectiveness of onabotulinumtoxinA injections can vary among patients. 25 More research is required to determine the optimal dosage and administration methods for onabotulinumtoxinA injections.

Future Research Directions

Future research should focus on investigating the long-term effects and safety of onabotulinumtoxinA injections. 12 Studies are also needed to explore methods for enhancing the effectiveness of onabotulinumtoxinA injections and minimizing associated risks. 2 Further research is required to compare the efficacy of onabotulinumtoxinA injections to other treatment modalities for refractory overactive bladder.

Conclusion

OnabotulinumtoxinA injections have the potential to be an effective and safe treatment for refractory overactive bladder. 12 However, it's crucial to carefully consider the potential risks, such as urinary retention and urinary tract infections, before administering the injections. 25 16 6 OnabotulinumtoxinA injections can be a valuable treatment option for patients with refractory overactive bladder, but careful patient selection and risk assessment are essential.

Literature analysis of 28 papers
Positive Content
22
Neutral Content
3
Negative Content
3
Article Type
5
1
2
2
28
1.

Different number of intravesical onabotulinumtoxinA injections for patients with refractory detrusor overactivity do not affect treatment outcome: A prospective randomized comparative study.

Author: LiaoChun-Hou, ChenSheng-Fu, KuoHann-Chorng

Improved bladder function
Reduced incontinence
Reduced urgency
Increased post-void residual urine
Urinary tract infection

A randomized controlled trial found that different numbers of intravesical onabotulinumtoxinA (BoNT-A) injections produced similar therapeutic and adverse effects in patients with detrusor overactivity (DO) refractory to antimuscarinics.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

4.

Injection technique of the upper face with onabotulinumtoxinA in chronic migraine.

Author: Boczarska-JedynakMagdalena, BlumenfeldAndrew M

Aesthetic benefits
Effective migraine prevention
Overdose

This review discusses the technique of onabotulinumtoxinA injections in the glabellar and frontal regions for preventing chronic migraine, using the PREEMPT paradigm. The review also addresses aesthetic concerns associated with these injections, emphasizing the importance of coordination between migraine and aesthetic injectors to avoid potential overdosing.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

5.

The effectiveness and safety of oral medications, onabotulinumtoxinA (three doses) and transcutaneous tibial nerve stimulation as non or minimally invasive treatment for the management of neurogenic detrusor overactivity in adults: a systematic review and network meta-analysis.

Author: ChenYuanzhuo, PengLiao, ZhangChi, ChenJiawei, ChenJiahui, ShenHong, LuoDeyi

Neurogenic detrusor overactivity treatment

Oral medications, onabotulinumtoxinA injections, and transcutaneous tibial nerve stimulation (TTNS) are recommended treatments for patients with neurogenic detrusor overactivity (NDO), according to American Urological Association/Society of Urodynamics guidelines.

Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

The Correlation of Diabetes Mellitus and Urinary Retention From Intravesical OnabotulinumtoxinA Injection for Overactive Bladder.

Author: TakashimaYoko, HandlerStephanie, LausKatharina, EckhardtSarah, WhitakerTaylor, TenggardjajaChristopher, YazdanyTajnoos

OAB treatment
BoNT injection
urinary retention

This study investigates whether patients with diabetes mellitus (DM) treated with intravesical onabotulinumtoxinA (BoNT) injection for overactive bladder (OAB) have increased urinary retention requiring clean intermittent catheterization (CIC).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

OnabotulinumtoxinA injection towards the SPG for treating symptoms of refractory chronic rhinosinusitis with nasal polyposis: a pilot study.

Author: JamtøyKent Are, TronvikErling, BratbakDaniel Fossum, CrespiJoan, StovnerLars Jacob, AschehougIrina, ThorstensenWenche Moe

BTA CRSwNP

This pilot study investigated the safety of onabotulinumtoxinA (BTA) injections into the sphenopalatine ganglion (SPG) in 10 patients with refractory chronic rhinosinusitis with nasal polyposis (CRSwNP) using a new injection tool.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

12.

OnabotulinumtoxinA is a well tolerated and effective treatment for refractory overactive bladder in real-world practice.

Author: HamidRizwan, Lorenzo-GomezMaria-Fernanda, Schulte-BauklohHeinrich, BoroujerdiAmin, PatelAnand, FarrellyElisabeth

OAB treatment

OnabotulinumtoxinA is an effective and well-tolerated treatment for overactive bladder in real-world clinical practice.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.

Language : English

13.

The First Injection: Rates of Urinary Retention in Women With Urgency Incontinence Treated With Intravesical OnabotulinumtoxinA Injection.

Author: SquiresNatalie A, MuellerMargaret G, Lewicky-GauppChristina, CollinsSarah A, KentonKimberly S, Geynisman-TanJulia

Urinary retention

10% of women who received an initial intravesical onabotulinumtoxinA (BnTA) injection for urgency urinary incontinence (UUI) experienced urinary retention requiring catheterization. Only 2% of women had asymptomatic retention, and 5% developed PVRs for 300 mL.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Urinary tract infection and drug-resistant urinary tract infection after intradetrusor onabotulinumtoxinA injection versus sacral neuromodulation.

Author: Elmer-LyonCaroline G, StreitJudy A, TakacsElizabeth B, Ten EyckPatrick P, BradleyCatherine S

Multidrug resistant UTI
Urinary tract infection

Botox injections into the bladder may increase the risk of urinary tract infections.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

17.

Temporary autonomic modulation with botulinum toxin type A to reduce atrial fibrillation after cardiac surgery.

Author: WaldronNathan H, CooterMary, HaneyJohn C, SchroderJacob N, GacaJeffrey G, LinShu S, SigurdssonMartin I, FudimMarat, PodgoreanuMihai V, Stafford-SmithMark, MilanoCarmelo A, PicciniJonathan P, MathewJoseph P

Safe
Well tolerated
No significant difference in POAF

Epicardial injection of onabotulinumtoxinA was safe for adults undergoing cardiac surgery, but it did not significantly reduce the risk of postoperative atrial fibrillation (POAF). While there was a trend towards reduced POAF in the BoNTA group, the study was underpowered to detect a smaller, but clinically meaningful, treatment effect.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

18.

Anatomical Look Into OnabotulinumtoxinA Injection for Chronic Migraine Headache.

Author: Wu-FienbergYuewei, AnsariHossein, ZardouzShawn, NarouzeSamer, BlahaTaryn, SwansonMarco, TotonchiAli

Needle depth issues

Body mass index (BMI) may impact the efficacy of onabotulinumtoxinA for chronic migraines, as subcutaneous fat may prevent intramuscular injection with standard needles, highlighting the importance of considering body habitus in treatment planning.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

19.

Higher Neural Correlates in Patients with Multiple Sclerosis and Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA.

Author: KhavariRose, EliasSaba N, PandeRashmi, WuKatherine M, BooneTimothy B, KarmonikChristof

Neurogenic overactive bladder treatment

OnabotulinumtoxinA is used to treat neurogenic overactive bladder, but its sensory effects are not fully understood. This study aimed to evaluate the impact of intradetrusor onabotulinumtoxinA injection on brain activity in female patients with multiple sclerosis and neurogenic overactive bladder.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.

Language : English

20.

Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity.

Author: JiangYuan-Hong, ChenSheng-Fu, JhangJia-Fong, KuoHann-Chorng

Improved voiding
Relaxed sphincter

This study analyzed the treatment outcomes and predictors for successful onabotulinumtoxinA treatment in patients with urethral sphincter hyperactivity resulting in voiding dysfunction.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

21.

Inconsistency in the Definition of Urinary Tract Infection after Intravesical Botulinum Toxin A Injection: A Systematic Review.

Author: StammAndrew W, AdelsteinSarah A, ChenAndrew, LucioniAlvaro, KobashiKathleen C, LeeUna J

Urinary tract infection definition

A systematic review found that there is a lack of consistency in the definition of urinary tract infection in studies of onabotulinumtoxinA injections, which makes it difficult to compare results.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

23.

Comparative study of efficacy and safety between bladder body and trigonal intravesical onabotulinumtoxina injection in the treatment of interstitial cystitis refractory to conventional treatment-A prospective, randomized, clinical trial.

Author: JiangYuan-Hong, JhangJia-Fong, LeeCheng-Ling, KuoHann-Chorng

IC/BPS relief

This study compared the therapeutic efficacy and safety of bladder body and trigonal BoNT-A injection for IC/BPS.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

24.

Current pharmacological and surgical treatment of underactive bladder.

Author: JiangYuan-Hong, LeeCheng-Ling, JhangJia-Fong, KuoHann-Chorng

DU treatment
UAB treatment
voiding efficiency

Underactive bladder (UAB) is a common urological condition that can be caused by various factors. This review discusses the different causes and treatment approaches for UAB, including pharmacotherapy and bladder outlet surgeries. The authors suggest that ablation of the bladder neck or prostatic urethra may not only reduce bladder outlet resistance but also abolish sympathetic hyperactivity that inhibits detrusor contractility.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

25.

What is the true catheterization rate after intravesical onabotulinumtoxinA injection?

Author: PatelDevin N, JamnagerwallaJuzar, HoumanJustin, AngerJennifer T, EilberKaryn S

Urinary retention

A known side effect of Botox injections for overactive bladder is urinary retention, which means that people can’t urinate easily. This study aimed to determine how often people needed to use a catheter to empty their bladder after a Botox injection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

26.

Does myofascial and trigger point treatment reduce pain and analgesic intake in patients undergoing onabotulinumtoxinA injection due to chronic intractable migraine?

Author: GandolfiMarialuisa, GeroinChristian, ValèNicola, MarchiorettoFabio, TurrinaAndrea, DimitrovaEleonora, TamburinStefano, SerinaAnna, CastellazziPaola, MeschieriAndrea, RicardFrançois, SaltuariLeopold, PicelliAlessandro, SmaniaNicola

Chronic migraine treatment

Chronic migraines are often associated with muscle tension in the neck. While medication is the main treatment, rehabilitation therapies to address muscle tension and trigger points may be helpful for managing headache symptoms.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

28.

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population.

Author: OnemKadir, BayrakOmer, DemirtasAbdullah, CoskunBurhan, DincerMurat, KocakIzzet, OnurRahmi,

OAB symptom improvement
Hematuria
Urinary infection
Urinary retention

Intradetrusor onabotulinumtoxinA (onaBoNT-A) injection significantly decreased urge urinary incontinence (UI) episodes, mean voiding frequency, and urgency episodes in patients with overactive bladder (OAB) refractory to antimuscarinic treatment. Urinary retention developed in 3.75% of patients, and urinary infection and transient hematuria were observed in 6.25% of patients each.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.

Language : English

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