Manns Kate, Khan Asher, Carlson Kevin V, Wagg Adrian, Baverstock Richard J, Trafford Crump R
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Neurourol Urodyn. 2022 Jan;41(1):42-47. doi: 10.1002/nau.24809. Epub 2021 Oct 7.
Injecting onabotulinumtoxinA (BoTN-A) into the bladder has been established as an effective treatment of overactive bladder (OAB) and well-tolerated by patients. However, there evidence suggests the efficacy and safety of this treatment may decrease with age due to increased comorbidities and frailty. This study's objective was to establish empirical evidence regarding age-related differences in outcomes related to BoTN-A for the treatment of idiopathic OAB.
MEDLINE, EMBASE, and the Cochrane Central Registry for Controlled Trials were systematically searched. Results were restricted to randomized control trials of BoTN-A bladder injections for the treatment of idiopathic OAB. The resulting articles' abstracts were screened independently by two reviewers. Those passing the screen were reviewed in full. Articles were excluded if participants were <18 years old, diagnosed with neurogenic overactivity, or treated with both oral medications and BoTN-A; if the frequency and severity of OAB symptoms were not specified; or, if symptoms were not stratified by age.
The initial search resulted in 1572 articles; 166 were reviewed in full. None met all inclusion/exclusion criteria. However, 21 studies met all criteria except age stratification. Authors were contacted to obtain raw data to perform an independent age-based analysis, but sufficient data was not received.
While the initial systematic review did not generate the expected results, it did reveal that age-related outcomes of BoTN-A for the treatment of OAB are significantly under-studied. Given that the prevalence of OAB increases with age, this is an important knowledge gap. Our article explains the rationale for further study in this area.
膀胱注射A型肉毒杆菌毒素（BoTN-A）已被确认为治疗膀胱过度活动症（OAB）的有效方法，且患者耐受性良好。然而，有证据表明，由于合并症增加和身体虚弱，这种治疗的疗效和安全性可能会随着年龄的增长而下降。本研究的目的是建立关于BoTN-A治疗特发性OAB相关结局的年龄差异的实证证据。
系统检索MEDLINE、EMBASE和Cochrane对照试验中央注册库。结果仅限于BoTN-A膀胱注射治疗特发性OAB的随机对照试验。两名评审员独立筛选所得文章的摘要。通过筛选的文章进行全文评审。如果参与者年龄<18岁、被诊断为神经源性膀胱过度活动症或同时接受口服药物和BoTN-A治疗；如果未明确OAB症状的频率和严重程度；或者，如果症状未按年龄分层，则排除这些文章。
初步检索得到1572篇文章；166篇进行了全文评审。没有一篇符合所有纳入/排除标准。然而，21项研究符合所有标准，只是未进行年龄分层。已联系作者以获取原始数据以进行基于年龄的独立分析，但未收到足够的数据。
虽然初步的系统评价未产生预期结果，但它确实表明，BoTN-A治疗OAB的年龄相关结局的研究明显不足。鉴于OAB的患病率随年龄增加，这是一个重要的知识空白。我们的文章解释了在该领域进一步研究的理由。
