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Treatment options for refractory urgency urinary incontinence include sacral neuromodulation, posterior tibial nerve stimulation, and onabotulinumtoxinA injection. Evidence to guide the choice of therapy is lacking. In an open-label randomized clinical trial that enrolled 386 women with refractory urgency urinary incontinence, Amundsen and colleagues found that treatment with onabotulinumtoxinA, compared with sacral neuromodulation, resulted in a small improvement in mean daily episodes of incontinence—3.9 fewer vs 3.3 fewer episodes per day, respectively. Treatment with onabotulinumtoxinA resulted in a higher risk of urinary tract infections and need for self-catheterizations.
Highlights. JAMA. 2016;316(13):1329-1331. doi:10.1001/jama.2015.14510