Efficacy and Impact of Botulinum Toxin A versus Anticholinergic Therapy for the Treatment of Bothersome Urge Urinary Incontinence

Urinary incontinence is a condition that markedly impacts quality of life. Conservative first line treatments for urge incontinence combined with other overactive bladder (OAB) symptoms include behavioral therapy, pelvic floor training +/- biofeedback, or the use of anticholinergic medications. These treatment modalities may not result in total continence and are often not sustained for various reasons. Thus, the objective of the Anticholinergic versus Botox Comparison Study (ABC) was to determine whether a single intra-detrusor injection of botulinum toxin A (Botox A�) is more effective than a standardized regimen of oral anticholinergics in reducing urge urinary incontinence (UUI). Oral anticholinergic therapy and Botox A� by injection were associated with similar reductions in the frequency of daily episodes of UUI. The group receiving Botox A� was less likely to have dry mouth and more likely to have complete resolution of UUI but had higher rates of transient urinary retention and urinary tract infections.