Intra-detrusor injection of Onabotulinumtoxin for lower urinary tract symptoms (LUTS) symptoms in patients with multiple sclerosis (MS): a systematic review and meta-analysis.

Background: Lower urinary tract symptoms (LUTS) are common complications in patients with multiple sclerosis (MS). Different studies evaluated the effects of Onabotulinumtoxin on urinary findings in patients with MS. We designed this systematic review and meta-analysis to estimate pooled efficacy of intra-detrusor injections of botox for urinary symptoms in patients with MS. Methods: A comprehensive systematic search was conducted on five databases of PubMed, Scopus, EMBASE, Web of Science, and Google scholar on February 2022. . We extracted data regarding the total number of participants, first author, publication year, the country of origin, mean age, F/M ratio, duration of the disease, duration of the treatment, mean Expanded Disability Status Scale (EDSS), maximum cystometric capacity (MCC), and maximum detrusor pressure (MDP). Results: Preliminary search of databases retrieved 1618 articles, after deduplication, 934 studies remained. Five studies were included for meta-analysis. The most frequent country of origin was the USA, and the mean EDSS ranged between 2.9 and 5.1. Urinary tract infection (UTI) and urinary retention were the most prevalent complications. The SMD of MDP (MDP week 12-MDP baseline) was -1.32(95%CI:-1.77, -0.37) (I2=52.9%, P=0.1). The SMD of MCC (MCC week 12-MCC baseline) was 1.65 (95%CI: 0.44, 2.86) (I2=92.4%, p<0.001). The SMD of MDP (MDP week 4-MDP baseline) was -3.6 (95%CI:-7.3, 0.16) (I2=98.3%, p<0.001). The SMD of MCC (MCC week 4-MCC baseline) was 5.05 (95%CI: 0.14, 9.96) (I2=98.8%, p<0.001). Conclusions: This systematic review and meta-analysis demonstrated that injection of intra-detrusor Onabotulinumtoxin had a positive effect on improving urodynamic findings in patients with MS.