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Comparing the Efficacy of OnabotulinumtoxinA, Sacral Neuromodulation, and Peripheral Tibial Nerve Stimulation as Third Line Treatment for the Management of Overactive Bladder Symptoms in Adults: Systematic Review and Network Meta-Analysis

1
Institute of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan
2
Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
3
School of Medicine, Buddhist Tzu Chi University, Hualien 97071, Taiwan
4
Department of Nephrology, Taipei Medical University-Shuang Ho Hospital, Taipei 23561, Taiwan
*
Author to whom correspondence should be addressed.
Toxins 2020, 12(2), 128; https://doi.org/10.3390/toxins12020128
Received: 11 December 2019 / Revised: 3 February 2020 / Accepted: 5 February 2020 / Published: 18 February 2020
The American Urological Association guidelines for the management of non-neurogenic overactive bladder (OAB) recommend the use of OnabotulinumtoxinA, sacral neuromodulation (SNM), and peripheral tibial nerve stimulation (PTNS) as third line treatment options with no treatment hierarchy. The current study used network meta-analysis to compare the efficacy of these three modalities for managing adult OAB syndrome. We performed systematic literature searches of several databases from January 1995 to September 2019 with language restricted to English. All randomized control trials that compared any dose of OnabotulinumtoxinA, SNM, and PTNS with each other or a placebo for the management of adult OAB were included in the study. Overall, 17 randomized control trials, with a follow up of 3–6 months in the predominance of trials (range 1.5–24 months), were included for analysis. For each trial outcome, the results were reported as an average number of episodes of the outcome at baseline. Compared with the placebo, all three treatments were more efficacious for the selected outcome parameters. OnabotulinumtoxinA resulted in a higher number of complications, including urinary tract infection and urine retention. Compared with OnabotulinumtoxinA and PTNS, SNM resulted in the greatest reduction in urinary incontinence episodes and voiding frequency. However, comparison of their long-term efficacy was lacking. Further studies on the long-term effectiveness of the three treatment options, with standardized questionnaires and parameters are warranted. View Full-Text
Keywords: network meta-analysis; OnabotulinumtoxinA; overactive bladder; peripheral tibial nerve stimulation; sacral neuromodulation network meta-analysis; OnabotulinumtoxinA; overactive bladder; peripheral tibial nerve stimulation; sacral neuromodulation
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Lo, C.-W.; Wu, M.-Y.; Yang, S. .-D.; Jaw, F.-S.; Chang, S.-J. Comparing the Efficacy of OnabotulinumtoxinA, Sacral Neuromodulation, and Peripheral Tibial Nerve Stimulation as Third Line Treatment for the Management of Overactive Bladder Symptoms in Adults: Systematic Review and Network Meta-Analysis. Toxins 2020, 12, 128.

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