{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:06Z","timestamp":1792108806905,"version":"4.4.0"},"reference-count":64,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004844","name":"National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NCKUH-11306009"],"award-info":[{"award-number":["NCKUH-11306009"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004844","name":"National Cheng Kung University Hospital","doi-asserted-by":"publisher","award":["NCKUH-11206016"],"award-info":[{"award-number":["NCKUH-11206016"]}],"id":[{"id":"10.13039\/501100004844","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Overactive bladder (OAB) significantly impairs quality of life in the elderly. Although the intradetrusor injection of botulinum toxin type A (BoNT-A) is a treatment option, its effects on older adults remain uncertain. This study aimed to evaluate the efficacy and safety of BoNT-A intradetrusor injections in elderly OAB patients through a systematic review and meta-analysis. A comprehensive literature search was conducted using the PubMed, Embase, Cochrane Library, Scopus, and CINAHL databases from inception to 30 May 2024. The primary outcomes were improvements in daily urinary incontinence (UI) episodes and patient-reported outcomes, while the secondary outcomes focused on potential adverse events. Four randomized controlled trials with 803 participants were included. BoNT-A injections significantly reduced daily UI episodes at 4\u20136 weeks (mean difference [MD]: \u22123.82; 95% confidence interval [CI]: \u22126.29 to \u22121.35) and at 12 weeks (MD: \u22122.17; 95% CI: \u22123.22 to \u22121.12). However, BoNT-A was associated with an increased risk of elevated post-void residual (Risk Difference [RD]: 0.154; 95% CI: 0.058 to 0.251) and urinary tract infection (RD: 0.111; 95% CI: 0.005 to 0.217), with no significant difference observed in the initiation of catheterization or hematuria. Trial sequential analysis confirmed a sufficient sample size and statistical power. In conclusion, while BoNT-A effectively manages OAB in the elderly, careful post-injection monitoring is warranted due to its potential risks.<\/jats:p>","DOI":"10.3390\/toxins16110484","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T03:53:14Z","timestamp":1731383594000},"page":"484","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Evaluating the Efficacy and Safety of Botulinum Toxin in Treating Overactive Bladder in the Elderly: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"16","author":[{"given":"Yu-Hsuan","family":"Chen","sequence":"first","affiliation":[{"name":"Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8105-1787","authenticated-orcid":false,"given":"Jen-Hao","family":"Kuo","sequence":"additional","affiliation":[{"name":"Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0884-9098","authenticated-orcid":false,"given":"Yen-Ta","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9143-7395","authenticated-orcid":false,"given":"Pei-Chun","family":"Lai","sequence":"additional","affiliation":[{"name":"Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7934-4882","authenticated-orcid":false,"given":"Yin-Chien","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3143-3357","authenticated-orcid":false,"given":"Yu-Ching","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1159\/000447205","article-title":"Overactive bladder syndrome: Evaluation and management","volume":"11","author":"Leron","year":"2018","journal-title":"Curr. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1002\/nau.22609","article-title":"Do we need a new definition of the overactive bladder syndrome? ICI-RS 2013","volume":"33","author":"Drake","year":"2014","journal-title":"Neurourol. Urodyn."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1757-5672.2011.00122.x","article-title":"Pathophysiology of overactive bladder","volume":"4","author":"En","year":"2012","journal-title":"LUTS Low. Urin. Tract Symptoms"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Przydacz, M., Gasowski, J., Grodzicki, T., and Chlosta, P. (2023). Lower Urinary Tract Symptoms and Overactive Bladder in a Large Cohort of Older Poles-A Representative Tele-Survey. J. Clin. Med., 12.","DOI":"10.3390\/jcm12082859"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1016\/j.eururo.2006.09.019","article-title":"Population-Based Survey of Urinary Incontinence, Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Countries: Results of the EPIC Study","volume":"50","author":"Irwin","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1016\/j.juro.2015.01.087","article-title":"Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA\/SUFU guideline amendment","volume":"193","author":"Gormley","year":"2015","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/luts.12262","article-title":"Pathophysiology of refractory overactive bladder","volume":"11","author":"Chen","year":"2019","journal-title":"LUTS Low. Urin. Tract Symptoms"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1159\/000455257","article-title":"Solifenacin in the elderly: Results of an observational study measuring efficacy, tolerability and cognitive effects","volume":"98","author":"Hampel","year":"2017","journal-title":"Urol. Int."},{"key":"ref_9","first-page":"620","article-title":"A pooled analysis of the efficacy of fesoterodine for the treatment of overactive bladder, and the relationship between safety, co-morbidity and polypharmacy in patients aged 65 years or older","volume":"46","author":"Wagg","year":"2017","journal-title":"Age Ageing"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jalz.2012.02.005","article-title":"Long-term anticholinergic use and the aging brain","volume":"9","author":"Cai","year":"2013","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1001\/jamainternmed.2014.7663","article-title":"Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study","volume":"175","author":"Gray","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.urology.2023.11.033","article-title":"Oxybutynin-associated Cognitive Impairment: Evidence and Implications for Overactive Bladder Treatment","volume":"186","author":"Chancellor","year":"2024","journal-title":"Urology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s40266-020-00783-w","article-title":"Safety and tolerability results from the PILLAR study: A phase iv, double-blind, randomized, placebo-controlled study of Mirabegron in patients \u2265 65 years with overactive bladder-wet","volume":"37","author":"Herschorn","year":"2020","journal-title":"Drugs Aging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s40266-020-00829-z","article-title":"Efficacy and safety of once-daily vibegron for treatment of overactive bladder in patients aged \u2265 65 and \u2265 75 years: Subpopulation analysis from the EMPOWUR randomized, international, phase III study","volume":"38","author":"Varano","year":"2021","journal-title":"Drugs Aging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.eururo.2005.12.012","article-title":"Quality of life changes in patients with neurogenic versus idiopathic detrusor overactivity after intradetrusor injections of botulinum neurotoxin type A and correlations with lower urinary tract symptoms and urodynamic changes","volume":"49","author":"Kalsi","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"I3","DOI":"10.1007\/PL00007816","article-title":"Pharmacology and immunology of botulinum toxin serotypes","volume":"248","author":"Aoki","year":"2001","journal-title":"J. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00345-016-1862-y","article-title":"Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms","volume":"35","author":"Marcelissen","year":"2017","journal-title":"World J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s40266-022-00950-1","article-title":"Bladder dysfunction in older adults: The botulinum toxin option","volume":"39","author":"Kao","year":"2022","journal-title":"Drugs Aging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.eururo.2005.12.010","article-title":"Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity","volume":"49","author":"Apostolidis","year":"2006","journal-title":"Eur. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1464-410X.2008.07822.x","article-title":"Mechanisms of action of intravesical botulinum treatment in refractory detrusor overactivity","volume":"102","author":"Drake","year":"2008","journal-title":"BJU Int."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lin, Y.-H., Chiang, B.-J., and Liao, C.-H. (2020). Mechanism of action of botulinum toxin A in treatment of functional urological disorders. Toxins, 12.","DOI":"10.3390\/toxins12020129"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1111\/bju.13945","article-title":"Comparative assessment of the efficacy of onabotulinumtoxinA and oral therapies (anticholinergics and mirabegron) for overactive bladder: A systematic review and network meta-analysis","volume":"120","author":"Drake","year":"2017","journal-title":"BJU Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.1016\/j.juro.2008.08.030","article-title":"Short-term efficacy of botulinum toxin a for refractory overactive bladder in the elderly population","volume":"180","author":"White","year":"2008","journal-title":"J. Urol."},{"key":"ref_24","first-page":"S91","article-title":"Onabotulinumtoxina has a positive safety and efficacy profile in overactive bladder (OAB) patients <65 and \u226565 years of age","volume":"34","author":"Moore","year":"2015","journal-title":"Neurourol. Urodyn."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/iju.14176","article-title":"OnabotulinumtoxinA (botulinum toxin type A) for the treatment of Japanese patients with overactive bladder and urinary incontinence: Results of single-dose treatment from a phase III, randomized, double-blind, placebo-controlled trial (interim analysis)","volume":"27","author":"Yokoyama","year":"2020","journal-title":"Int. J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2608","DOI":"10.1016\/j.juro.2009.01.117","article-title":"Outcome of a randomized, double-blind, placebo controlled trial of botulinum A toxin for refractory overactive bladder","volume":"181","author":"Flynn","year":"2009","journal-title":"J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.juro.2008.03.028","article-title":"Refractory idiopathic urge urinary incontinence and botulinum A injection","volume":"180","author":"Brubaker","year":"2008","journal-title":"J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1016\/j.juro.2010.02.009","article-title":"Outcomes of intravesical botulinum toxin for idiopathic overactive bladder symptoms: A systematic review of the literature","volume":"183","author":"Anger","year":"2010","journal-title":"J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Duthie, J.B., Vincent, M., Herbison, G.P., Wilson, D.I., and Wilson, D. (2011). Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst. Rev., CD005493.","DOI":"10.1002\/14651858.CD005493.pub3"},{"key":"ref_30","first-page":"29","article-title":"Botulinum toxin injection for refractory non-neurogenic overactive bladder. Systematic review","volume":"36","author":"Henriet","year":"2015","journal-title":"Rev. Medicale Brux."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1159\/000351037","article-title":"Botulinum toxin-A injections for idiopathic overactive bladder: A systematic review and meta-analysis","volume":"91","author":"Cui","year":"2013","journal-title":"Urol. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1007\/s11884-017-0406-7","article-title":"The aging overactive bladder: A review of aging-related changes from the brain to the bladder","volume":"12","author":"Suskind","year":"2017","journal-title":"Curr. Bladder Dysfunct. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ou, Y.-C., Kao, Y.-L., Ho, Y.-H., Wu, K.-Y., and Kuo, H.-C. (2023). Intravesical Injection of Botulinum Toxin Type A in Patients with Refractory Overactive Bladder\u2014Results between Young and Elderly Populations, and Factors Associated with Unfavorable Outcomes. Toxins, 15.","DOI":"10.3390\/toxins15020095"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.4111\/icu.2020.61.S1.S33","article-title":"Clinical application of intravesical botulinum toxin type A for overactive bladder and interstitial cystitis","volume":"61","author":"Chen","year":"2020","journal-title":"Investig. Clin. Urol."},{"key":"ref_35","first-page":"506","article-title":"Urinary incontinence in the elderly population","volume":"61","author":"Loh","year":"2006","journal-title":"Med. J. Malays."},{"key":"ref_36","first-page":"e11599","article-title":"Effect of urinary incontinence on the quality of life of older adults in Riyadh: Medical and sociocultural perspectives","volume":"12","author":"Alshammari","year":"2020","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/j.eururo.2011.12.011","article-title":"Repeated botulinum toxin type A injections for refractory overactive bladder: Medium-term outcomes, safety profile, and discontinuation rates","volume":"61","author":"Dowson","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.urology.2019.04.018","article-title":"Outcomes for intravesical abobotulinumtoxin A (Dysport) treatment in the active management of overactive bladder symptoms\u2014A prospective study","volume":"130","author":"Craciun","year":"2019","journal-title":"Urology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1007\/s11255-023-03891-9","article-title":"Investigation of intradetrusor onabotulinum toxin A efficacy and safety in older adults with urge urinary incontinence","volume":"56","author":"Basin","year":"2024","journal-title":"Int. Urol. Nephrol."},{"key":"ref_40","first-page":"76","article-title":"Botulinum-A Toxin\u2019s efficacy in the treatment of idiopathic overactive bladder","volume":"65","author":"Moga","year":"2015","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1016\/j.juro.2010.08.021","article-title":"Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: A double-blind, placebo controlled, randomized, dose ranging trial","volume":"184","author":"Dmochowski","year":"2010","journal-title":"J. Urol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1016\/j.juro.2012.12.022","article-title":"OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: Results of a phase 3, randomized, placebo controlled trial","volume":"189","author":"Nitti","year":"2013","journal-title":"J. Urol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1016\/j.juro.2012.11.089","article-title":"Increased risk of large post-void residual urine and decreased long-term success rate after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity","volume":"189","author":"Liao","year":"2013","journal-title":"J. Urol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/JU.0000000000000525","article-title":"Treatment response and complications after intradetrusor onabotulinumtoxinA injection in male patients with idiopathic overactive bladder syndrome","volume":"203","year":"2020","journal-title":"J. Urol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Wang, C.-C., Jiang, Y.-H., and Kuo, H.-C. (2020). The pharmacological mechanism of diabetes mellitus-associated overactive bladder and its treatment with botulinum toxin A. Toxins, 12.","DOI":"10.3390\/toxins12030186"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1002\/nau.22494","article-title":"Diabetes mellitus does not affect the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with refractory detrusor overactivity","volume":"33","author":"Wang","year":"2014","journal-title":"Neurourol. Urodyn."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/j.eururo.2010.09.007","article-title":"Adverse events of intravesical botulinum toxin a injections for idiopathic detrusor overactivity: Risk factors and influence on treatment outcome","volume":"58","author":"Kuo","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Kuo, H.-C. (2022). Clinical application of botulinum neurotoxin in lower-urinary-tract diseases and dysfunctions: Where are we now and what more can we do?. Toxins, 14.","DOI":"10.3390\/toxins14070498"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1002\/nau.24879","article-title":"Botulinum toxin for treating overactive bladder in men: A systematic review","volume":"41","author":"Truzzi","year":"2022","journal-title":"Neurourol. Urodyn."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/luts.12280","article-title":"High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections","volume":"12","author":"Lee","year":"2020","journal-title":"LUTS Low. Urin. Tract Symptoms"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1111\/j.1442-2042.2004.00943.x","article-title":"Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization","volume":"11","author":"Seki","year":"2004","journal-title":"Int. J. Urol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kuo, Y.-C., and Kuo, H.-C. (2016). Adverse events of intravesical onabotulinumtoxina injection between patients with overactive bladder and interstitial cystitis\u2014Different mechanisms of action of botox on bladder dysfunction?. Toxins, 8.","DOI":"10.3390\/toxins8030075"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/nau.22378","article-title":"Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: Some revered, few forgotten, others ignored","volume":"33","author":"Vasudeva","year":"2014","journal-title":"Neurourol. Urodyn."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Wang, C.-C., Chou, E.C.-L., Chuang, Y.-C., Lin, C.-C., Hsu, Y.-C., Liao, C.-H., and Kuo, H.-C. (2021). Effectiveness and safety of intradetrusor onabotulinumtoxina injection for neurogenic detrusor overactivity and overactive bladder patients in Taiwan\u2014A phase IV prospective, interventional, multiple-center study (Restore study). Toxins, 13.","DOI":"10.3390\/toxins13120911"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s11934-017-0707-6","article-title":"Changes in management of poorly compliant bladder in botulinum toxin a era","volume":"18","author":"Prakash","year":"2017","journal-title":"Curr. Urol. Rep."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/acel.12320","article-title":"Global analyses revealed age-related alterations in innate immune responses after stimulation of pathogen recognition receptors","volume":"14","author":"Metcalf","year":"2015","journal-title":"Aging Cell"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Espi, M., Koppe, L., Fouque, D., and Thaunat, O. (2020). Chronic kidney disease-associated immune dysfunctions: Impact of protein-bound uremic retention solutes on immune cells. Toxins, 12.","DOI":"10.3390\/toxins12050300"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.3389\/fimmu.2020.01582","article-title":"The effects of type 2 diabetes mellitus on organ metabolism and the immune system","volume":"11","author":"Daryabor","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"111","DOI":"10.5213\/inj.2142224.112","article-title":"Aging-associated changes in oxidative stress negatively impacts the urinary bladder urothelium","volume":"26","author":"Kullmann","year":"2022","journal-title":"Int. Neurourol. J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40266-015-0335-0","article-title":"OnabotulinumtoxinA treatment for overactive bladder in the elderly: Practical points and future prospects","volume":"33","author":"Kuo","year":"2016","journal-title":"Drugs Aging"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.3389\/fphar.2019.01618","article-title":"Meta-Analysis of Randomized Controlled Trials Using Botulinum Toxin A at Different Dosages for Urinary Incontinence in Patients With Overactive Bladder","volume":"10","author":"Gong","year":"2020","journal-title":"Front. Pharmacol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1007\/s00192-023-05579-1","article-title":"Bleeding risk in female patients undergoing intravesical injection of onabotulinumtoxinA for overactive bladder: A Danish retrospective cohort study","volume":"34","author":"Elissaoui","year":"2023","journal-title":"Int. Urogynecol. J."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"138","DOI":"10.17085\/apm.21038","article-title":"Trial sequential analysis: Novel approach for meta-analysis","volume":"16","author":"Kang","year":"2021","journal-title":"Anesth. 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