Toxicon : official journal of the International Society on Toxinology · 2026
Efficacy and durability of therapies for neurogenic lower urinary tract dysfunction: A network meta-analysis of Botulinum Toxin a, instillations, and neuromodulation.
СтатьяNetwork Meta-AnalysisОбзорНазвание и аннотация: Перевод в очереди
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Lei Beibei, Lan Cunyu, Wang Yage, Ma Shenhong, Wang Heling, Zhang Di, Han Qiaohua, Zhuang Weisheng
Аннотация
OBJECTIVE: To evaluate the short-term efficacy and long-term sustainability of botulinum toxin A (BTA), instillations, and neuromodulation for neurogenic lower urinary tract dysfunction (NLUTD). This analysis addresses the clinical need to balance immediate symptom relief with sustained therapeutic stability.
METHODS: We searched databases through October 2025. Outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), and incontinence episode frequency (IEF). OnabotulinumtoxinA and AbobotulinumtoxinA were analyzed as distinct nodes to account for potency differences.
RESULTS: Across 25 RCTs (3779 participants), most BTA regimens, capsaicin, and N/OFQ significantly increased short-term MCC. Abo-BTA 600U [MD = 174.57; 95% CI: 168.19, 180.94] and Abo-BTA 750U-30 [MD = 171.03; 95% CI: 133.71, 208.35] showed the greatest gains. Long-term, only Abo-BTA (500U, 750U-15/30) and FES maintained larger estimated effects for MCC/MDP. Regarding IEF, Abo-BTA 800U showed the largest short-term reduction [MD = -14.32; 95% CI: -18.16, -10.48], while only Abo-BTA 750U remained effective long-term, indicating time-dependent attenuation. rTMS was safest, whereas high-dose BTA increased risks.
CONCLUSION: Detrusor-injected BTA demonstrates potential as a favorable intervention for NLUTD, with Abo-BTA(600U) or Ona-BTA(300U) exhibiting a balanced profile between efficacy and safety. Although the clinical benefits of most BTA formulations diminish over time, Abo-BTA (specifically 750U administered via 30 sites) ranked higher in statistical probability for long-term durability in this analysis. This longitudinal discrepancy may reflect a paucity of extended follow-up data for Ona-BTA rather than intrinsic therapeutic failure. These results suggest that higher injection-site density might be associated with enhanced treatment durability, while remaining interventions showed less consistent evidence of benefit compared with placebo. Given the indirect nature of the comparisons and the focus on single-injection data, these findings should be interpreted as exploratory.
METHODS: We searched databases through October 2025. Outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), and incontinence episode frequency (IEF). OnabotulinumtoxinA and AbobotulinumtoxinA were analyzed as distinct nodes to account for potency differences.
RESULTS: Across 25 RCTs (3779 participants), most BTA regimens, capsaicin, and N/OFQ significantly increased short-term MCC. Abo-BTA 600U [MD = 174.57; 95% CI: 168.19, 180.94] and Abo-BTA 750U-30 [MD = 171.03; 95% CI: 133.71, 208.35] showed the greatest gains. Long-term, only Abo-BTA (500U, 750U-15/30) and FES maintained larger estimated effects for MCC/MDP. Regarding IEF, Abo-BTA 800U showed the largest short-term reduction [MD = -14.32; 95% CI: -18.16, -10.48], while only Abo-BTA 750U remained effective long-term, indicating time-dependent attenuation. rTMS was safest, whereas high-dose BTA increased risks.
CONCLUSION: Detrusor-injected BTA demonstrates potential as a favorable intervention for NLUTD, with Abo-BTA(600U) or Ona-BTA(300U) exhibiting a balanced profile between efficacy and safety. Although the clinical benefits of most BTA formulations diminish over time, Abo-BTA (specifically 750U administered via 30 sites) ranked higher in statistical probability for long-term durability in this analysis. This longitudinal discrepancy may reflect a paucity of extended follow-up data for Ona-BTA rather than intrinsic therapeutic failure. These results suggest that higher injection-site density might be associated with enhanced treatment durability, while remaining interventions showed less consistent evidence of benefit compared with placebo. Given the indirect nature of the comparisons and the focus on single-injection data, these findings should be interpreted as exploratory.