Abstract：
OBJECTIVE: This systematic review and meta-analysis aimed to compare the effectiveness and safety of submucosal injection of onabotulinum toxin A (OnabotA) with intradetrusor injection for overactive bladder syndrome (OAB).
METHODS: This systematic review is registered with PROSPERO (CRD42021237964). A licensed librarian surveyed Medline, EMBASE, Scopus, and Google Scholar databases to conduct a comprehensive search. Studies comparing suburothelial and intradetrusor techniques of OnabotA injection for OAB were included, along with clinical and urodynamic variables and complications. The studies were assessed for quality on the basis of Cochrane Collaboration guidelines and evaluated using statistical analysis via a random-effect model and I2 statistic. Data extraction and analysis were conducted using Covidence systematic review platform and Review Manager software.
RESULTS: Six studies with 299 patients were included in the systematic review, with four reporting that suburothelial injection of OnabotA was as effective as intradetrusor injection and two reporting intradetrusor injection to be more effective. The meta-analysis found no significant difference between the suburothelial and intradetrusor groups for mean daily catheter or voiding frequency (mean difference: 2.12 [95% confidence interval (CI): -1.61, 5.84]) and the mean number of urgency/urge incontinence episodes (mean difference: 0.08 [95% CI: -1.42, 1.57]). However, a significant heterogeneity was found among the studies. Only the mean volume at first detrusor contraction showed a significant difference, being higher for suburothelial injection (mean difference: 33.39 [95% CI: 0.16, 66.63]). No significant difference was noted for mean compliance, mean bladder capacity, and mean maximum detrusor pressure. Urinary tract infections (UTIs) (p = 0.24) and acute urinary retention (p = 0.92) showed no significant difference between the two groups. The risk of bias varied among the studies.
CONCLUSIONS: Suburothelial injection of OnabotA is as effective as intradetrusor injection in improving OAB symptoms, and it has similar complication rates. A higher mean volume of the first detrusor contraction was found in a urodynamic study with suburothelial injection.
METHODS: This systematic review is registered with PROSPERO (CRD42021237964). A licensed librarian surveyed Medline, EMBASE, Scopus, and Google Scholar databases to conduct a comprehensive search. Studies comparing suburothelial and intradetrusor techniques of OnabotA injection for OAB were included, along with clinical and urodynamic variables and complications. The studies were assessed for quality on the basis of Cochrane Collaboration guidelines and evaluated using statistical analysis via a random-effect model and I2 statistic. Data extraction and analysis were conducted using Covidence systematic review platform and Review Manager software.
RESULTS: Six studies with 299 patients were included in the systematic review, with four reporting that suburothelial injection of OnabotA was as effective as intradetrusor injection and two reporting intradetrusor injection to be more effective. The meta-analysis found no significant difference between the suburothelial and intradetrusor groups for mean daily catheter or voiding frequency (mean difference: 2.12 [95% confidence interval (CI): -1.61, 5.84]) and the mean number of urgency/urge incontinence episodes (mean difference: 0.08 [95% CI: -1.42, 1.57]). However, a significant heterogeneity was found among the studies. Only the mean volume at first detrusor contraction showed a significant difference, being higher for suburothelial injection (mean difference: 33.39 [95% CI: 0.16, 66.63]). No significant difference was noted for mean compliance, mean bladder capacity, and mean maximum detrusor pressure. Urinary tract infections (UTIs) (p = 0.24) and acute urinary retention (p = 0.92) showed no significant difference between the two groups. The risk of bias varied among the studies.
CONCLUSIONS: Suburothelial injection of OnabotA is as effective as intradetrusor injection in improving OAB symptoms, and it has similar complication rates. A higher mean volume of the first detrusor contraction was found in a urodynamic study with suburothelial injection.
摘要：
目的：本系统评价和荟萃分析旨在比较膀胱过度活动症（OAB）的粘膜下注射甲化安毒素（OnabotA）与逼尿肌内注射的有效性和安全性。
方法：本系统综述在PROSPERO（CRD42021237964）注册。一位持牌图书管理员调查了Medline，EMBASE,Scopus,和谷歌学者数据库进行全面搜索。包括比较OAB的OnabotA注射的皮下和逼尿肌技术的研究，以及临床和尿动力学变量和并发症。根据Cochrane协作指南对研究进行质量评估，并通过随机效应模型和I2统计量使用统计分析进行评估。使用Covidence系统评价平台和ReviewManager软件进行数据提取和分析。
结果：系统评价中纳入了六项研究，共有299名患者，其中有4例报告显示,上皮下注射OnabotA与逼尿肌内注射同样有效,有2例报告显示,逼尿肌内注射更有效.荟萃分析发现，在平均每日导管或排尿频率（平均差：2.12[95％置信区间（CI）：-1.61，5.84]）和平均急迫性/急迫性尿失禁发作次数（平均差：0.08[95％CI：-1.42，1.57]）方面，上皮下和逼尿肌组之间没有显着差异。然而,在研究中发现了显著的异质性。只有第一次逼尿肌收缩时的平均体积表现出显著差异，皮下注射较高（平均差：33.39[95％CI：0.16，66.63]）。平均依从性没有显著差异，平均膀胱容量，和最大逼尿肌压力。尿路感染（UTIs）（p=0.24）和急性尿潴留（p=0.92）在两组之间没有显着差异。偏倚的风险在研究中有所不同。
结论：上皮下注射OnabotA在改善OAB症状方面与逼尿肌内注射同样有效，并发症发生率相似.在进行肾下注射的尿动力学研究中，发现第一次逼尿肌收缩的平均体积更高。
方法：本系统综述在PROSPERO（CRD42021237964）注册。一位持牌图书管理员调查了Medline，EMBASE,Scopus,和谷歌学者数据库进行全面搜索。包括比较OAB的OnabotA注射的皮下和逼尿肌技术的研究，以及临床和尿动力学变量和并发症。根据Cochrane协作指南对研究进行质量评估，并通过随机效应模型和I2统计量使用统计分析进行评估。使用Covidence系统评价平台和ReviewManager软件进行数据提取和分析。
结果：系统评价中纳入了六项研究，共有299名患者，其中有4例报告显示,上皮下注射OnabotA与逼尿肌内注射同样有效,有2例报告显示,逼尿肌内注射更有效.荟萃分析发现，在平均每日导管或排尿频率（平均差：2.12[95％置信区间（CI）：-1.61，5.84]）和平均急迫性/急迫性尿失禁发作次数（平均差：0.08[95％CI：-1.42，1.57]）方面，上皮下和逼尿肌组之间没有显着差异。然而,在研究中发现了显著的异质性。只有第一次逼尿肌收缩时的平均体积表现出显著差异，皮下注射较高（平均差：33.39[95％CI：0.16，66.63]）。平均依从性没有显著差异，平均膀胱容量，和最大逼尿肌压力。尿路感染（UTIs）（p=0.24）和急性尿潴留（p=0.92）在两组之间没有显着差异。偏倚的风险在研究中有所不同。
结论：上皮下注射OnabotA在改善OAB症状方面与逼尿肌内注射同样有效，并发症发生率相似.在进行肾下注射的尿动力学研究中，发现第一次逼尿肌收缩的平均体积更高。
