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Neurotoxin Versus Neuromodulation for the Treatment of Refractory Overactive Bladder Syndrome

Michael B. Chancellor a, Frank Costa b, Hann-Chorng Kuo c

aDepartment of Urology, William Beaumont Hospital, Royal Oak, MI, USA
bUrology Institute of Pittsburgh, Pittsburgh, PA, USA
cDepartment of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Overactive bladder (OAB) is common and is estimated to affect 16.5% of the adult population. In patients refractory to pharmacotherapy, new treatment modalities, such as neuromodulation and botulinum toxin (BoNT), have had encouraging results. Neuromodulation has promising efficacious results in treating refractory OAB, urinary retention and bowel dysfunction, but the reoperation rate is relatively high, and the full mechanism of action of sacral nerve modulation is incompletely understood. BoNT is another potential alternative to surgical intervention for patients with refractory OAB, neurogenic detrusor overactivity and interstitial cystitis. BoNT-A injection in patients with idiopathic detrusor overactivity have reported increases in cystometric capacity, improved subjective symptoms and urodynamic parameters, and improved quality of life. BoNT injection offers an efficacious, minimally invasive alternative to sacral nerve modulation for the treatment of refractory OAB.


Detrusor overactivity; Neuromodulation; Neurotoxin; Overactive bladder


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