PMID- 28745818 OWN - NLM STAT- MEDLINE DCOM- 20191014 LR - 20191014 IS - 1520-6777 (Electronic) IS - 0733-2467 (Linking) VI - 37 IP - 2 DP - 2018 Feb TI - Is repeat Botulinum Toxin A injection valuable for neurogenic detrusor overactivity-A systematic review and meta-analysis. PG - 542-553 LID - 10.1002/nau.23354 [doi] AB - AIM: To investigate the value of repeat botulinum toxin A (BTX-A) injections in patients with neurogenic detrusor overactivity (NDO). METHODS: We searched the PubMed, EMBASE, and EBSCO databases for articles published until June 2016. Studies that reported the efficacy and safety of repeat BTX-A injections for adult patients with NDO were eligible. The effect size for each outcome was calculated as the standardized mean difference +/- standard error and 95% confidence interval, and was graded as small, >0.2; moderate, >0.5; or large, >0.8. The outcomes included maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), reflex volume (RV), bladder compliance (BC), quality of life (QOL), and injection interval. Descriptive reviews were performed for urinary incontinence (UI) and adverse events (AEs). RESULTS: Eighteen studies involving 1533 patients whose level of evidence ranged from 3 to 4 were included in this study. We noted non-significant changes in MCC, MDP, RV, and BC between the first and last injections. Patients who had received /=5 injections were found to have a significant decrease in QOL after the last injection. No significant differences in injection intervals were noted after repeat BTX-A injections, and the repeat injection failure rate was low. CONCLUSION: Our study demonstrated that repeat BTX-A injections allow sustained improvements in patients with NDO. The rate of AEs was stable and low. However, additional high-quality, large-scale, and long-term trials are necessary to establish the efficacy and safety of >/=5 repeat BTX-A injections. CI - (c) 2017 Wiley Periodicals, Inc. FAU - Ni, Jianshu AU - Ni J AD - Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. FAU - Wang, Xiaohu AU - Wang X AD - Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. FAU - Cao, Nailong AU - Cao N AUID- ORCID: 0000-0001-9328-6543 AD - Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. FAU - Si, Jiemin AU - Si J AD - Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. FAU - Gu, Baojun AU - Gu B AUID- ORCID: 0000-0001-5090-3767 AD - Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20170726 PL - United States TA - Neurourol Urodyn JT - Neurourology and urodynamics JID - 8303326 RN - 0 (Neuromuscular Agents) RN - EC 3.4.24.69 (Botulinum Toxins, Type A) SB - IM MH - Botulinum Toxins, Type A/*therapeutic use MH - Humans MH - Injections MH - Neuromuscular Agents/*therapeutic use MH - Quality of Life MH - Retreatment MH - Urinary Bladder, Neurogenic/complications/*drug therapy MH - Urinary Bladder, Overactive/complications/*drug therapy MH - Urinary Incontinence/*drug therapy/etiology OTO - NOTNLM OT - adverse event OT - multiple sclerosis OT - quality of life OT - spinal cord injury OT - urinary incontinence EDAT- 2017/07/27 06:00 MHDA- 2019/10/15 06:00 CRDT- 2017/07/27 06:00 PHST- 2017/01/12 00:00 [received] PHST- 2017/05/31 00:00 [accepted] PHST- 2017/07/27 06:00 [pubmed] PHST- 2019/10/15 06:00 [medline] PHST- 2017/07/27 06:00 [entrez] AID - 10.1002/nau.23354 [doi] PST - ppublish SO - Neurourol Urodyn. 2018 Feb;37(2):542-553. doi: 10.1002/nau.23354. Epub 2017 Jul 26.