JAMA

Midurethral sling vs. onabotulinumtoxinA for urinary incontinence

May 7, 2025

Study details: The MUSA trial compared intradetrusor onabotulinumtoxinA (100 U) and midurethral sling surgery in females aged ≥21 years with moderate to severe mixed urinary incontinence unresponsive to conservative treatments and oral medications. Conducted at seven U.S. sites from July 2020 to September 2022, participants were randomized to receive either treatment, with follow-ups until December 29, 2023.

Results: Out of 150 females, 137 (mean age, 59 years) were included in the primary analysis. Both treatments significantly improved Urogenital Distress Inventory (UDI) scores at 6 months, with no significant difference between groups (onabotulinumtoxinA: -66.8 points; sling: -84.9 points; mean difference, 18.1 points; P = 0.12). The sling group showed greater improvement in UDI stress scores (P < 0.001), but no significant difference in UDI irritative scores (P = 0.27). Adverse events were similar.

Clinical impact: Both treatments effectively improved mixed urinary incontinence symptoms, with no significant difference in overall symptom improvement at 6 months. Treatment choice may depend on patient preference and specific symptom profiles, especially given the greater improvement in stress incontinence with the sling. These results support shared decision-making between clinicians and patients.

Source:

Harvie HS; National Institute of Child Health and Human Development Pelvic Floor Disorders Network; et al. (2025, May 5). JAMA. Midurethral Sling vs OnabotulinumtoxinA in Females With Urinary Incontinence: The MUSA Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40323617/