Botox as effective as medication for urinary urgency incontinence

Botox® (onabotulinum toxin-A) injections to the bladder are as effective as medication for treating urinary urgency incontinence in women, but the injection is twice as likely to completely resolve symptoms. These findings were published in the latest issue of The New England Journal of Medicine by a National Institutes of Health clinical trials network including Loyola University Chicago Stritch School of Medicine (SSOM).

Urgency incontinence is urinary incontinence with a strong or sudden need to urinate. Traditionally, this condition has been treated with drugs known as anticholinergics, which reduce bladder contractions by targeting the bladder muscle through the nervous system. However, many women who take anticholinergic medications experience side effects, including constipation, dry mouth and dry eyes.

“Prior to this study, we reserved onabotulinum toxin-A for women who did not respond to traditional oral medication,” said Linda Brubaker, MD, MS, co-author and dean, SSOM. “However, this research supports the use of either of these approaches as appropriate first-line treatment in women.”

An estimated 15.7 percent of U.S. women experience urinary incontinence. Women are twice as likely to experience urinary incontinence as men.

This study evaluated 241 women with urinary urgency incontinence. One group of participants received six-months of daily oral medication plus a saline injection. The other group received one injection of onabotulinum toxin-A (Botox) plus a daily oral placebo capsule. At the beginning of the study, patients had an average of five urgency incontinence episodes a day. The average reduction in episodes over six months was 3.4 with oral medication and 3.3 with onabotulinum toxin-A. The proportion of women with complete resolution of urgency incontinence was 13 percent with anticholinergics and 27 percent with onabotulinum toxin-A. Quality of life improved in both groups without significant differences. More participants in the anticholinergic group reported dry mouth (46 percent versus 31 percent) while the onabotulinum toxin-A group had more urinary tract infections (28 percent versus 15 percent) and more incomplete bladder emptying, requiring temporary bladder catheterization (5 percent versus 0 percent).

“These results will help doctors weigh treatment options for women and make recommendations based on individual patient needs,” said Dr. Brubaker, who is in the Division of Female Pelvic & Reconstructive Surgery, Loyola University Health System.

LUHS’ Division of Female Pelvic Medicine and Reconstructive Surgery was the first of its kind in greater Chicago. It is still one of the few centers in the country that offers a single location for the multi-disciplinary diagnosis and treatment of women with pelvic floor disorders. LUHS’ urogynecological surgeons, doctors with the combined expertise of gynecology and urology, provide the most advanced medical and surgical care available for women with problems related to the lower urinary tract and the pelvic floor.

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Nora Dudley
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Loyola University Health System