What are the short-term benefits and potential harms of therapeutic modalities for the management of overactive bladder syndrome in women? A review of evidence under the auspices of the European Association of Urology, Female Non-Neurogenic LUTS Guidelines Panel

Context
Overactive bladder syndrome (OAB) is highly prevalent among women and has negative impact on their quality of life. The current available treatments for OAB symptoms include conservative, pharmacological, or surgical modalities.
Objectives
To provide an updated contemporary evidence document regarding OAB treatment options and determine the short-term effectiveness, safety, and potential harms of the available treatment modalities for women with OAB syndrome.
Evidence Acquisition and methods
The Medline, Embase and Cochrane controlled trials databases and clinicaltrial.gov were searched for all relevant publications up to May 2022. Risk of bias assessment followed the recommended tool in the Cochrane Handbook for Systematic Reviews of Interventions and quality of evidence was assessed using modified GRADE criteria. Meta-analysis was performed where appropriate.
Evidence Synthesis
Antimuscarinics and Beta-3 agonists were significantly more effective than placebo across most outcomes, with beta-3 agonists more effective at reducing nocturia episodes and antimuscarinics causing significantly higher adverse events.
Onabotulinumtoxin-A was more effective than placebo across most outcomes, but with significantly higher rates of AUR/CISC (6-8 times) and UTIs (2-3 times). Onabot-A was also significantly better than antimuscarinics in cure of UUI but not in reduction of mean UUI episodes.
SNS success rate were significantly higher than antimuscarinics (61% vs. 42%, p = 0.02), with similar rates of adverse events. SNS and Onabot-A were not significantly different in efficacy outcomes. Satisfaction rates were higher with Onabot-A, but with a higher rate of recurrent UTIs (24% VS. 10%). SNS was associated with 9% removal rate and 3% revision rate.
Conclusions and Patient Summary
Overactive bladder is a manageable condition, with first line treatment options including antimuscarinics, beta-3 agonists and PTNS. Second-line options include onabotulinumtoxin-A bladder injections or sacral nerve stimulation. The choice of therapies should be guided by individual patient factors.