Combination therapy studies of third-line treatments were rare and centered on medication with PTNS .
Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious .
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life .
The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) .
For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % .
The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown .
Our objective was to determine the volume of data supporting combination therapy in treating OAB .
OnabotulinumtoxinA vs Sacral Neuromodulation on Refractory Urgency Urinary Incontinence in Women: A Randomized Clinical Trial.
Importance Women with refractory urgency urinary incontinence are treated with sacral neuromodulation and onabotulinumtoxinA with limited comparative information . Objective To assess whether onabotulinumtoxinA is superior to sacral neuromodulation in controlling refractory episodes of urgency urinary incontinence . Design , Setting , and Participants Multicenter open-label r and omized trial ( February 2012-January 2015 ) at 9 US medical centers involving 381 women with refractory urgency urinary incontinence . Interventions Cystoscopic intradetrusor injection of 200 U of onabotulinumtoxinA ( n = 192 ) or sacral neuromodulation ( n = 189 ) . Main Outcomes and Measures Primary outcome , change from baseline mean number of daily urgency urinary incontinence episodes over 6 months , was measured with monthly 3-day diaries . Secondary outcomes included change from baseline in urinary symptom scores in the Overactive Bladder Question naire Short Form ( SF ) ; range , 0 - 100 , higher scores indicating worse symptoms ; Overactive Bladder Satisfaction question naire ; range , 0 - 100 ; includes 5 subscales , higher scores indicating better satisfaction ; and adverse events . Results Of the 364 women ( mean [ SD ] age , 63.0 [ 11.6 ] years ) in the intention-to-treat population , 190 women in the onabotulinumtoxinA group had a greater reduction in 6-month mean number of episodes of urgency incontinence per day than did the 174 in the sacral neuromodulation group ( -3.9 vs -3.3 episodes per day ; mean difference , 0.63 ; 95 % CI , 0.13 to 1.14 ; P = .01 ) . Participants treated with onabotulinumtoxinA showed greater improvement in the Overactive Bladder Question naire SF for symptom bother ( -46.7 vs -38.6 ; mean difference , 8.1 ; 95 % CI , 3.0 to 13.3 ; P = .002 ) ; treatment satisfaction ( 67.7 vs 59.8 ; mean difference , 7.8 ; 95 % CI , 1.6 to 14.1 ; P = .01 ) and treatment endorsement ( 78.1 vs 67.6 ; mean difference ; 10.4 , 95 % CI , 4.3 to 16.5 ; P < .001 ) than treatment with sacral neuromodulation . There were no differences in convenience ( 67.6 vs 70.2 ; mean difference , -2.5 ; 95 % CI , -8.1 to 3.0 ; P = .36 ) , adverse effects ( 88.4 vs 85.1 ; mean difference , 3.3 ; 95 % CI , -1.9 to 8.5 ; P = .22 ) , and treatment preference ( 92.% vs 89 % ; risk difference , -3 % ; 95 % CI , -16 % to 10 % ; P = .49 ) . Urinary tract infections were more frequent in the onabotulinumtoxinA group ( 35 % vs 11 % ; risk difference , -23 % ; 95 % CI , -33 % to -13 % ; P < .001 ) . The need for self-catheterization was 8 % and 2 % at 1 and 6 months in the onabotulinumtoxinA group . Neuromodulation device revisions and removals occurred in 3 % . Conclusions and Relevance Among women with refractory urgency urinary incontinence , treatment with onabotulinumtoxinA compared with sacral neuromodulation result ed in a small daily improvement in episodes that although statistically significant is of uncertain clinical importance . In addition , it result ed in a higher risk of urinary tract infections and need for transient self-catheterizations
Combination therapy studies of third-line treatments were rare and centered on medication with PTNS .
Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious .
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life .
The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) .
For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % .
The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown .
Our objective was to determine the volume of data supporting combination therapy in treating OAB .