Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials
<p>The PRISMA flow chart. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RCT, randomized controlled trials; CINAHL, Cumulative Index to Nursing and Allied Health Literature; Embase, Excerpta Medica Database. * Individuals who were not specifically patients with overactive bladder; ** studies where botulinum toxin was not administered via direct injection into the detrusor muscle, but rather, through alternative methods, such as instillation.</p> "> Figure 2
<p>Change in daily urinary incontinence episodes in BoNT-A group and placebo group. (<b>a</b>) Forest plot for weeks 4–6. (<b>b</b>) Forest plot for week 12. (<b>c</b>) Trial sequential analysis plot. UI, urinary incontinence; BoNT-A, botulinum toxin type A; TSA, trial sequential analysis; CI, confidence interval.</p> "> Figure 3
<p>Change in patient-reported outcomes in BoNT-A group and placebo group. Forest plot of (<b>a</b>) symptom improvement, (<b>b</b>) quality of life, and (<b>c</b>) treatment-based response. QoL, quality of life; BoNT-A, botulinum toxin type A; CI, confidence interval.</p> "> Figure 4
<p>Incidence of urinary tract infection in BoNT-A group and placebo group. (<b>a</b>) Forest plot. (<b>b</b>) Subgroup analysis of 100 U and 200 U doses. (<b>c</b>) Trial sequential analysis plot. UTI, urinary tract infection; BoNT-A, botulinum toxin type A; TSA, trial sequential analysis; CI, confidence interval.</p> "> Figure 5
<p>Incidence of post-voiding residual ≥ 200 mL in BoNT-A group and placebo group. (<b>a</b>) Forest plot. (<b>b</b>) Subgroup analysis of 100 U and 200 U doses. (<b>c</b>) Trial sequential analysis plot. PVR, post-voiding residual; BoNT-A, botulinum toxin type A; TSA, trial sequential analysis; CI, confidence interval.</p> "> Figure 6
<p>Incidence of clean intermittent catheterization in BoNT-A group and placebo group. (<b>a</b>) Forest plot. (<b>b</b>) Subgroup analysis. (<b>c</b>) Trial sequential analysis plot. CIC: clean intermittent catheterization; BoNT-A: botulinum toxin type A; TSA: trial sequential analysis; CI, confidence interval.</p> "> Figure 7
<p>Incidence of hematuria in BoNT-A group and placebo group. (<b>a</b>) Forest plot. (<b>b</b>) Trial sequential analysis plot. BoNT-A, botulinum toxin type A; TSA, trial sequential analysis; CI, confidence interval.</p> ">
Abstract
:1. Introduction
2. Results
2.1. Literature Search and Study Selection
2.2. Study Characteristics
2.3. Risk of Bias Assessment
2.4. Daily Urinary Incontinence (UI) Episodes
2.5. Patient-Reported Outcomes
2.6. Adverse Events
2.6.1. Urinary Tract Infections (UTI)
2.6.2. Post-Voiding Residual (PVR)
2.6.3. Initiation of Clean Intermittent Catheterization (CIC)
2.6.4. Hematuria
3. Discussion
4. Conclusions
5. Materials and Methods
5.1. Eligibility Criteria
5.2. Search Strategy
5.3. Study Selection and Data Extraction
5.4. Quality Assessment
5.5. Statistical Analysis
5.5.1. Conventional Meta-Analysis
5.5.2. Trial Sequential Analysis (TSA)
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Study Design | Region | Trial Registration No. | Population | Group | Sample Size | Gender: Female, n (%) | Mean Age, Years | Intervention and Comparison | Treatment Duration |
---|---|---|---|---|---|---|---|---|---|---|
Yokoyama et al. (2020) [25] | RCT | Japan | NCT02820844 | OAB | Intervention | 124 | 92 (74) | 65.9 | BoNT-A 100 U | 12 weeks |
Control | 124 | 94 (76) | Placebo | |||||||
Moore et al. (2015) [24] | RCT | UK/USA | NCT00910520 NCT0091845 | OAB | Intervention | 245 | - | >65 | BoNT-A 100 U | 12 weeks |
Control | 225 | - | Placebo | |||||||
Flynn et al. (2009) [26] | RCT | USA | NCT00178191 | OAB | Intervention | 15 | - | 66 | BoNT-A 200 U or 300 U | 6 weeks |
Control | 7 | - | Placebo | |||||||
Brubaker et al. (2008) [27] | RCT | USA | NCT00373789 | OAB | Intervention | 28 | 100% | 66.3 | BoNT-A 200 U | 4 weeks |
Control | 15 | 100% | Placebo |
First Author | Randomization Process | Intervention Adherence | Missing Outcome Data | Outcome Measurement | Selective Reporting | Overall RoB |
---|---|---|---|---|---|---|
Yokoyama et al. (2020) [25] | S 1 | L | S 2 | L | L | H |
Moore et al. (2015) [24] | S 1 | L | S 2 | L | L | H |
Flynn et al. (2009) [26] | L | L | L | L | L | L |
Brubaker et al. (2008) [27] | S 1 | L | S 3 | L | S 4 | H |
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Chen, Y.-H.; Kuo, J.-H.; Huang, Y.-T.; Lai, P.-C.; Ou, Y.-C.; Lin, Y.-C. Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. Toxins 2024, 16, 484. https://doi.org/10.3390/toxins16110484
Chen Y-H, Kuo J-H, Huang Y-T, Lai P-C, Ou Y-C, Lin Y-C. Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. Toxins. 2024; 16(11):484. https://doi.org/10.3390/toxins16110484
Chicago/Turabian StyleChen, Yu-Hsuan, Jen-Hao Kuo, Yen-Ta Huang, Pei-Chun Lai, Yin-Chien Ou, and Yu-Ching Lin. 2024. "Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials" Toxins 16, no. 11: 484. https://doi.org/10.3390/toxins16110484
APA StyleChen, Y. -H., Kuo, J. -H., Huang, Y. -T., Lai, P. -C., Ou, Y. -C., & Lin, Y. -C. (2024). Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. Toxins, 16(11), 484. https://doi.org/10.3390/toxins16110484