Sacral neuromodulation and intravesical botulinum toxin for refractory overactive bladder

Purpose of review To provide an overview of sacral neuromodulation (SNM) and intravesical botulinum toxin (BTX) injections in the treatment of refractory overactive bladder (OAB) and urge urinary incontinence. Recent findings SNM has been a successful treatment option for OAB for over a decade with efficacy rates reported between 50 and 90%. Recently, intravesical BTX has been studied as a less invasive but more transient option with similar efficacy rates. Side-effect profiles differ greatly between the treatments, with elevated postvoid residuals and urinary tract infections most commonly occurring after botulinum injection and pain or device revision or removal occurring with SNM. Recent studies have tried to elucidate the optimal dosing regimen for BTX and patient variables predicting success for both therapies in order to improve outcomes while reducing adverse events. Summary Both intravesical BTX and SNM have been shown to be effective treatment options for OAB. Further research is needed to determine equivalence or if one therapy is superior and to identify the ideal patient population for each therapy.