Study design, materials and methods
Search strategy: PubMed and EMBASE were searched using the search terms ‘‘Botulinum Toxin A’’, “Sacral nerve stimulation”, ‘‘ refractory overactive bladder syndrome”. The conference abstracts and some other content-independent articles were not included in this systematic review. We combined the search results and removed duplicate articles in order to obtain an initial set of potentially eligible studies.Study inclusion criteria: Studies were considered eligible if they met all the following inclusion criteria: (1) The type of studies should be a randomized trial (2) All participants in each study should be women with refractory OAB (3) As for the outcome ,a study report included: a. The OAB clinical symptoms improved. Conditions (such as the change in urgency frequency .(4)As for the controls, should us SNS to treat refractory OAB ,another group should us Botox-A treatment.Study exclusion criteria:(1)If the necessary data were extrapolated from the reported outcomes (2)If the outcomes of interest were not described evidently(3)If patient with UTI.Data extraction: Articles after removing duplicate were assessed independently by two authors for possible inclusion. They also extracted data on first author, publication year, patients sources, study size, mean age of patients, follow-up times. Statistical methods: All calculations and data manipulations were performed using RevMan 5.3 (Cochrane Collaboration, Oxford, UK). Survival data were log-transformed and pooled results were expressed in terms of the log(OR) and standard error of the log(OR) .The Begg's test was performed and funnel plots were generated in STATA 13.0 (STATA Corp., College Station, USA) to assess the potential publication bias; p>0.05 was interpreted to indicate the absence of significant publication bias.
Interpretation of results
In total,2 studies with 853 patients were included. Our results indicated women with refractory OAB receiving sacral nerve stimulation (SNS) gained a greater improvement than botulinumtoxin A (Botox) injection[risk ratio(RR)0.91,95% CI 0.45-1.85].The failure rate Botox –A group was higher than SNS group [risk ratio(RR)1.60,95% CI 0.27-9.41].The complication rate ,such as urinary tract infection(UTI),was lower in SNS group than in Botox-A group[risk ratio(RR)2.90,95% CI 2.00-4.21].