Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence
Visco, A. G., Brubaker, L., Richter, H. E., Nygaard, I., Paraiso, M. F. R., Menefee, S. A., ... Meikle, S. F. (2012). Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence. New England Journal of Medicine, 367(19), 1803-1813. DOI: 10.1056/NEJMoa1208872
Urgency urinary incontinence is characterized by unpredictable loss of urine; it is a prevalent condition that occurs disproportionately in women, affecting up to 19% of older women in the United States. 1 Anticholinergic medications are used as the primary treatment for this condition. A recent systematic review of trials comparing treatments for urgency urinary incontinence showed that none of the six drugs evaluated was superior to another in treating the condition and that current evidence was insufficient to guide the choice among other therapies, including injections of botulinum toxin.2 OnabotulinumtoxinA is effective in treating urgency urinary incontinence that is resistant to anticholinergic therapy, but this treatment can result in incomplete bladder emptying, necessitating temporary bladder catheterization.3 Data directly comparing onabotulinumtoxinA with anticholinergic agents have been lacking. We conducted a randomized trial comparing an oral anticholinergic medication regimen with a single injection into the detrusor muscle of onabotulinumtoxinA in women with urgency urinary incontinence to assess the reduction in episodes of urgency urinary incontinence over the course of 6 months, improvement in quality of life, and side effects.