Study Compares Treatments for Urinary Incontinence in Women

By Sondra Forsyth

Holly Richter, Ph.D., M.D., co-authored a paper in October 2106 showing the comparison of Botox A and sacral neuromodulation to control bladder incontinence. In a study appearing in the Journal of the American Medical Association, Holly E. Richter, Ph.D., M.D., director of the University of Alabama at Birmingham Division of Urogynecology and Pelvic Reconstructive Surgery, and colleagues assessed whether injection of Botox A is superior to sacral neuromodulation, or the use of an implanted electrode for bladder control, in managing episodes of refractory urgency urinary incontinence in women.

A release by Alicia Rohan from the university quotes Dr. Richter as saying, “This study will help guide clinicians offering these treatment modalities with information to better individualize treatment for women with refractory urgency urinary incontinence. Our findings suggest that the optimal treatment for women with refractory urinary incontinence is through the use of Botox A.”

The release explains that urgency urinary incontinence is a sudden need to void resulting in uncontrollable urine loss. This disruptive condition is common and increases with age, from 17 percent of women older than 45 years to 27 percent older than 75 years in the United States. Women who are not responsive to treatment of urinary incontinence are treated with Botox A and sacral neuromodulation. However, there is limited comparative information regarding these two treatment approaches.

Botox A stops the nerve signals to cells, paralyzing the bladder muscle. Sacral neuromodulation involves the implantation of a small electrode tip near the sacral nerve to control voiding function in the lower spine. The implanted device stimulates the nerve to act as a sort of pacemaker for the bladder.

For this study, conducted at nine medical centers in the United States, the researchers randomly assigned women with refractory urgency urinary incontinence to sacral neuromodulation or an injection of Botox A, also known as onabotulinumtoxinA. Of the 364 women with an average age of 63 years, in the intention-to-treat population, 190 in the onabotulinumtoxinA group had a statistically significant greater reduction in mean daily urinary incontinence episodes over six months than did the 174 in the sacral neuromodulation group. Participants treated with onabotulinumtoxinA showed greater improvement in an overactive bladder questionnaire for symptom bother, treatment satisfaction and treatment endorsement than those treated with sacral neuromodulation.

However, there was no significant difference in quality of life or for measures of treatment preference, convenience or adverse effects. OnabotulinumtoxinA did increase the risk of urinary tract infections and need for transient intermittent self-catheterizations.

“Although there was a small difference in reduction of daily urinary incontinence episodes between the two treatment groups, other outcomes provide information that should be discussed with patients in helping them choose which treatment is best for them,” Richter said.