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An indirect comparison meta-analysis of noninvasive intravesical instillation and intravesical injection of botulinum toxin-A in bladder disorders

  • Urology - Original Paper
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Abstract

Background

Botulinum toxin type A (BTX-A) intravesical instillation and BTX-A intravesical injection are both effective treatments or overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS), but direct comparative studies of the two treatments are lacking.

Methods

We conducted a pairs-comparison meta-analysis and an adjusted indirect comparison meta-analysis extracting published data from randomized controlled trials in literature databases from the inception of each database to Aug. 31, 2021, evaluating efficacy and safety of BTX-A intravesical instillation and BTX-A intravesical injection. We also carried out a subgroup analysis.

Results

We identified 24 trials in 21 studies were included in our study, of which 18 trials in 17 studies were BTX-A intravesical injections, 6 trials in 4 studies were BTX-A intravesical instillation. Compared with the normal saline injection, BTX-A intravesical injections for patients with OAB and IC/ BPS can obviously improve the symptoms of urinary frequency, urgency episode, UI and UUI, but BTX-A significantly increased the rate of urinary retention and urinary tract infection and increased PVR (p < 0.05). Adjusted indirect comparison meta-analysis showed that BTX-A intravesical injections was more effective than BTX-A intravesical instillation (p > 0.05). Surprisingly, BTX-A intravesical instillation had fewer side effects than BTX-A intravesical injections (p < 0.05).

Conclusions

Although BTX-A intravesical injections of OAB and IC/BPS has been significantly superior the BTX-A intravesical instillation, it has major side effects, but this needs to be confirmed by more large-scale, multicenter, direct comparison randomized controlled trials.

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Authors and Affiliations

  1. Department of Urology, Chengdu Second People’s Hospital, Chengdu, China

    Gao Yunfeng, Lai Fei, Liu Junbo, Yang Dingyuan & Huang Chaoyou

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  1. Gao Yunfeng
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  2. Lai Fei
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  3. Liu Junbo
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  4. Yang Dingyuan
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Correspondence to Huang Chaoyou.

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Supplementary Figure 1. The funnel plot for assessing risk of bias (JPG 109 KB)

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Yunfeng, G., Fei, L., Junbo, L. et al. An indirect comparison meta-analysis of noninvasive intravesical instillation and intravesical injection of botulinum toxin-A in bladder disorders. Int Urol Nephrol 54, 479–491 (2022). https://doi.org/10.1007/s11255-022-03107-6

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  • DOI: https://doi.org/10.1007/s11255-022-03107-6

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