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NICE backs Botox for overactive bladder

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Women with overactive bladder syndrome should be offered treatment with Botox in some cases, according to guidance from the National Institute for Health and Care Excellence.

The Botulinum toxin A product, better known for its association with cosmetics, is included in latest guidelines published this week by the institute.

NICE has issued an updated clinical guideline on the management of urinary incontinence in women, stating that it hopes to help “stop them suffering in silence”.

The update provides clinicians with latest advice on available treatment options for those affected by urinary incontinence and is intended to sit alongside NICE’s current guideline on the condition, which was published in 2006.

Three of the key recommendations made in the update are on treating overactive bladder syndrome. They cover both drug and invasive treatments.

NICE said women with overactive bladder syndrome or mixed urinary incontinence should be offered the choice of using the antimuscarinic drugs, oxybutynin or tolterodine (immediate release) or darifenacin (once daily) as a first line treatment.

If the first treatment is not effective or well tolerated another drug with the lowest acquisition cost should be offered, the update said.

Women should also be offered a face-to-face or telephone review four weeks after the start of each new drug treatment.

NICE added that if women with proven overactive bladder syndrome have not responded to conservative management, including drug therapy, they should be offered bladder wall injections with Botulinum toxin A after discussing the risks and benefits.

To coincide with the publication of the guidance last week, the Medicines and Healthcare Products Regulatory Agency granted Botox – manufactured by Allergan – a license for treating overactive bladder, which it had previously lacked.  

Robert Dixon, chief executive of the Bladder and Bowel Foundation, said: “We know that existing treatments are not always suitable for everyone and welcome a new treatment option that increases patient choice and offers an alternative for people who may not be able to tolerate established solutions.”

Meanwhile, on surgical procedures for stress urinary incontinence, NICE said that if conservative treatment had failed women should be offered a procedure using a synthetic mid-urethral tape.

Professor Mark Baker, director of NICE’s Centre for Clinical Practice, said: “Urinary incontinence is a distressing condition affecting the lives of millions of women of all ages.

“Over the years we have seen an increase in women seeking treatment, yet many others are still suffering in silence and not receiving the appropriate care for their condition.

“This updated clinical guideline suggests a range of treatments that women should be able to access to limit the distress that urinary incontinence can cause.”


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