Refractory overactive bladder patients who chose sacral neuromodulation therapy after failed OnabotulinumtoxinA treatment: A systematic review and meta-analysis.,PLOS ONE

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Refractory overactive bladder patients who chose sacral neuromodulation therapy after failed OnabotulinumtoxinA treatment: A systematic review and meta-analysis.
PLOS ONE ( IF 2.9 ) Pub Date : 2020-03-30 , DOI: 10.1371/journal.pone.0230355
Guang Yang ₁ , Yong Xu ₁ , Genyi Qu ₁ , Yulong Zhang ₁

Affiliation

Objective

To systematically review outcomes in patients with refractory overactive bladder (OAB) patients who underwent sacral neuromodulation therapy (SNM) therapy after unsuccessful onabotulinumtoxinA (BTX) therapy, and to compare outcomes with those who SNM as initial therapy.

Methods

A systematic search of Cochrane Library, Pubmed and Embase databases from July 2002 to November 2019, to analyze randomized controlled trials and retrospective studies of SNM therapy after failed initial BTX therapy. Two reviewers independently screened the studies and extracted data. A quality assessment of the included literature was conducted using Newcastle-Ottawa Scale (NOS), and Stata 12.0 software was used to conduct a meta-analysis of the collected data.

Results

A total of seven studies involving 319 patients were finally included. The success rate in refractory OAB patients who used SNM therapy after failed BTX therapy was 58.5%, 95% CI (0.47–0.70). There was no significant difference between refractory OAB patients who chose SNM as replacement therapy after failed BTX therapy and those who used SNM therapy as first choice [RR = 0.96, 95%CI (0.72–1.26), P = 0.735].

Conclusion

OAB patients for whom an initial choice of BTX therapy ends in failure or dissatisfaction may consider switching to SNM therapy. There is no difference in outcomes between these patients and those whose first choice was SNM therapy.

中文翻译：

OnabotulinumtoxinA治疗失败后选择神经调节疗法的难治性膀胱过度活动症患者：系统评价和荟萃分析。

目的

若要系统地审查难治性膀胱过度活动症（OAB）患者在不成功的肉毒杆菌毒素A（BTX）治疗之后接受神经调节治疗（SNM）治疗的患者的结局，并将其与作为初始治疗的SNM进行比较。

方法

2002年7月至2019年11月对Cochrane Library，Pubmed和Embase数据库进行系统搜索，以分析初始BTX治疗失败后SNM治疗的随机对照试验和回顾性研究。两名评论者独立筛选研究并提取数据。使用纽卡斯尔-渥太华量表（NOS）对纳入文献进行质量评估，并使用Stata 12.0软件对收集到的数据进行荟萃分析。

结果

最终纳入了涉及319名患者的总共7项研究。在BTX治疗失败后使用SNM治疗的难治性OAB患者中，成功率为58.5％，95％CI（0.47–0.70）。在BTX治疗失败后选择SNM作为替代治疗的难治性OAB患者与以SNM治疗为首选的难治性OAB患者之间无显着差异[RR = 0.96，95％CI（0.72-1.26），P = 0.735]。