Botulinum toxin type A injections into the urethral sphincter for idiopathic chronic non-obstructive urinary retention
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3 Committee considerations
The evidence
3.1 NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 6 sources, which was discussed by the committee. The evidence included 1 randomised controlled trial and 5 case series. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.
3.2 The professional experts and the committee considered the key efficacy outcomes to be: symptom relief, improvement in quality of life, a reduction in the need and frequency of self-catheterisation, improved bladder emptying and a reduction in the need for further procedures.
3.3 The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection, stress urinary incontinence, bladder outlet obstruction and botulinum toxicity.
3.4 Patient commentary was sought but none was received.
Committee comments
3.5 The committee was informed that a multidisciplinary team should decide who the procedure is suitable for.
3.6 Women have the procedure more commonly than men.
3.7 The procedure is most likely to be useful in people with sphincter overactivity.
3.8 The randomised controlled trial evidence was from people with a mixed group of indications.
Tom Clutton-Brock
Chair, interventional procedures advisory committee
December 2022
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