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InterStim Sacral Neuromodulation and Botox Botulinum-A Toxin Intradetrusor Injections for Refractory Urge Urinary Incontinence: A Decision Analysis Comparing Outcomes Including Efficacy and Complications

Shepherd, Jonathan P. MD, MSc; Lowder, Jerry L. MD, MSc; Leng, Wendy W. MD; Smith, Kenneth J. MD

Female Pelvic Medicine & Reconstructive Surgery: July-August 2011 - Volume 17 - Issue 4 - p 199-203
doi: 10.1097/SPV.0b013e318224e0d7
Original Articles
Journal Club

Objective: Overactive bladder is a common disease for which current pharmaceutical therapy is often unsatisfactory. Newer modalities, including Botox and InterStim, can be used when antimuscarinics fail. We compare InterStim and Botox using decision analysis.

Methods: A Markov state transition decision analysis model was constructed using values for efficacy and complications from the literature. Overall utility was compared monthly. Multiple 1-way sensitivity analyses were performed.

Results: For every month during the simulation, overall utility was higher for Botox than InterStim. After 54 months, cumulative utility was 3.86 versus 3.74, favoring Botox for an average yearly quality-adjusted life-year value of 0.86 versus 0.83. All differences were less than minimally important differences for utilities. Few meaningful thresholds were established supporting the robustness of the model.

Conclusions: Until appropriately powered randomized controlled trials are available, both InterStim and Botox are reasonable and effective strategies with similar outcomes.

Quality adjusted life year outcomes were similar between Interstim and Botox throughout the 54-month decision analysis model despite different complications between the 2 strategies. Supplemental digital content is available in the text.

From the *Division of Urogynecology and Reconstructive Pelvic Surgery, Departments of Obstetrics, Gynecology, and Reproductive Sciences, †Urology, and ‡Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.

Reprints: Jonathan P. Shepherd, MD, MSc, Department of Obstetrics and Gynecology, 300 Halket St, Pittsburgh, PA 15213. E-mail:

The authors did not receive funding for this study.

This study was presented as a poster at the 31st Annual Meeting of the American Urogynecologic Society, September 29 to October 2, 2010, Long Beach, Calif.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

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