Botox Ok for Some Patients With OAB, but Not All

Diedtra Henderson

May 26, 2014

OnabotulinumtoxinA, approved by the US Food and Drug Administration (FDA) in 2013 to treat overactive bladder (OAB), may be an appropriate second-line treatment option for select patients with OAB, according to a joint committee opinion by the American College of Obstetricians and Gynecologists and the American Urogynecologic Society.

The committee opinion was published in the June issue of Obstetrics & Gynecology.

The key symptoms of OAB include the bladder squeezing out urine at the wrong time, resulting in urination 8 or more times a day or 2 or more times at night. The committee notes that OAB is accompanied by frequency and nocturia, sometimes accompanied by urge urinary incontinence and in the absence of urinary tract infection.

Remedies include medicines that relax the muscles and nerves. OnabotulinumtoxinA, marketed as Botox A (Allergan), is a neurotoxin that paralyzes muscles and blunts nerve response and that has been found to significantly improve symptoms of OAB up to 1 year after injection.

However, before considering onabotulinumtoxinA, physicians should confirm OAB by appropriate evaluation and instruct patients on such nonmedical interventions as bladder retraining drills and timed voids, fluid management, or pelvic muscle exercises.

If use of onabotulinumtoxinA is being considered, shared decision making between patient and provider should include a discussion about the severity and inconvenience of symptoms and the risk–benefit balance for the patient. Risks associated with onabotulinumtoxinA include urine retention after the procedure, urinary tract infections, pain, body weakness, and the transient nature of the neurotoxin's effect, often necessitating additional injections.

The committee also emphasizes that providers who perform such injections should be trained in treating women with pelvic floor disorders, such as subspecialists in female pelvic medicine and urologists; have operative cystoscopy privileges; and have the skill to contend with possible adverse effects.

There are currently no evidence-based recommendations about patient follow-up postinjection. Providers should contact patients 3 to 7 days after the procedure to assess efficacy and possible voiding issues. Because the bladder may not empty completely, providers should assess postvoid residual urine volume by catheterization or bladder ultrasound in the office if further assessment is warranted.

Obstet Gynecol. 2014;123:1408-1411. Full text

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