Recommendation ID
Sequence of invasive OAB procedures:- What is the effectiveness and optimum sequence of treatment with botulinum toxin A and percutaneous sacral nerve stimulation for the treatment of OAB after failed conservative (including drug) management?
Any explanatory notes
(if applicable)
Why is this important:- It is not currently known which treatment option, either botulinum toxin A or percutaneous sacral nerve stimulation, is the most effective in the medium- and long-term for women with OAB in whom initial treatment, including OAB drugs, has failed. The initial outlay for percutaneous sacral nerve stimulation is high but when successful it appears to be effective. Botulinum toxin A also has a high failure rate but a lower outlay and it is not yet understood the cost threshold (in terms of treatment cycles or length of follow-up) at which botulinum toxin A is likely to be the less cost-effective option compared with percutaneous sacral nerve stimulation. Currently, funding for percutaneous sacral nerve stimulation is on an individual basis because of its high cost, leading to geographical inequalities in access. A head-to-head longitudinal study of these 2 treatments would determine both which should be offered first and at what point in the treatment pathway. Such studies have not been done. This evidence could reduce inequalities in access to treatment. In subsequent NICE guidance, evidence would be available to inform recommendations on the treatment pathway and at which point in the treatment pathway for OAB each of these options should be offered. It would also provide more robust information to patients about the risk of adverse events and support women's choice about whether to proceed with treatment.

Source guidance details

Comes from guidance
Urinary incontinence in women: management
Date issued
September 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 08/10/2013