Efficacy and safety of onabotulinumtoxinA in treating neurogenic detrusor overactivity: a systematic review and meta-analysis.

Background: OnabotulinumtoxinA is widely used in treating neurogenic detrusor overactivity (NDO). We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating NDO. Methods: We searched the following databases: Medline, EMBASE, and the Cochrane Controlled Trials Register. All published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of NDO were identified in the analysis. The reference lists of the retrieved studies were also investigated. Results: Four publications involving a total of 807 patients were identified in the analysis, which compared onabotulinumtoxinA with placebo. The changes of the mean number of urinary incontinence per week (the standardized mean difference [SMD] = −10.91, 95% confidence intervals [ CI s] = −14.18-−7.63, P CI = 126.19-165.99, P CI = −37.83-−27.48, P RR ] =1.48, 95% CI = 1.20-1.81, P = 0.0002); hematuria ( RR = 1.81, 95% CI = 1.00-3.24, P = 0.05) and urinary retention ( RR = 5.87, 95% CI = 3.61-9.56, P Conclusions: This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for NDO with side effects primarily localized to urinary tract.