Urge incontinence, also called urgency, is characterized by sudden uncontrollable urges to urinate and frequent urination. The condition is more common in women and prevalence increases with age. In the United States, urge incontinence affects approximately 17 percent of women over the age of 45, and 27 percent of women 75 and older.
When first- and second-line treatment measures for symptoms of urge incontinence—fluid restriction, pelvic floor training, and medications, for example—are unsuccessful, procedures such as sacral neuromodulation or onabotulinumtoxinA (Botox therapy) may be used to treat the condition.
According to the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH,sacral neuromodulation is a minimally invasive procedure in which a battery-operated stimulator is implanted under the skin of the lower back near the sacral nerve. The device emits electrical impulses that increase blood flow to the bladder and help strengthen pelvic muscles to improve bladder control. Botox therapy involves onabotulinumtoxinA injections into the bladder to relax the organ, increase its capacity, and decrease urge incontinence. Both procedures are performed using local anesthesia.
Results of a recent study comparing Botox to sacral neuromodulation for urge incontinence show that, while onabotulinumtoxinA produces slightly better results, it increases the risk for adverse effects, including urinary tract infections (UTIs) and the need for intermittent self-catheterization.
The study, called the Refractory Overactive Bladder: Sacral Neuromodulation vs Botulinum Toxin Assessment (ROSETTA) trial, was published in JAMA. It involved 364 women, and the average age was 63 years old. Participants were randomly assigned to receive Botox (190 women) or undergo sacral neuromodulation (174 women).
According to researchers, the Botox group experienced a greater decrease in urgency (-3.9 episodes per day) compared to the sacral neuromodulation group (-3.3 episodes). Women treated with onabotulinumtoxinA also experienced a greater improvement in symptoms as indicated by the Overactive Bladder Questionnaire, and a higher level treatment satisfaction overall.
However, UTI frequency was 35 percent in women who received Botox and just 11 percent in the neuromodulation group. The study findings indicate that the risks and benefits of each procedure should be carefully considered before deciding on a treatment option for urge incontinence.