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NCT04171531: MUSA

Sling vs Botox for Mixed Incontinence

Completed Phase 3 Results posted Last updated 3 June 2025
What this trial tests

Phase 3 trial testing Botox® injection in Urinary Incontinence, Stress in 150 participants. Completed in 12 February 2024.

Timeline
8 June 2020
Primary endpoint
12 February 2024
12 February 2024

Quick facts

Lead sponsorNICHD Pelvic Floor Disorders Network
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment150
Start date8 June 2020
Primary completion12 February 2024
Estimated completion12 February 2024
Sites8 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

NICHD Pelvic Floor Disorders Network

Who can join

21 and older, female only, with Urinary Incontinence, Stress or Urinary Incontinence, Urge. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

UDI-LF Total Score Change From Baseline Primary · 3, 6, 9, and 12 Months

The Urogenital Distress Inventory is a standardized a measure of overactive bladder symptoms and health-related quality of life. The UDI scale has a range from 0 to 300 with higher scores indicating greater distress. The outcome is calculated as the difference in score at 3, 6, or 12 months and the score at baseline.

3.0
GroupValue95% CI
Botox A-82.2-100 – -64.4
Mid-Urethral Sling-84.6-101 – -68.3
6.0
GroupValue95% CI
Botox A-74.9-93.6 – -56.1
Mid-Urethral Sling-89.1-104.7 – -73.5
9.0
GroupValue95% CI
Botox A-63.1-81.8 – -44.5
Mid-Urethral Sling-85.6-102.7 – -68.6
12.0
GroupValue95% CI
Botox A-67.7-85.7 – -49.8
Mid-Urethral Sling-89.2-107.5 – -70.9
UDI-LF Stress Score Change From Baseline Secondary · 3, 6, 9, and 12 Months

The Urogenital Distress Inventory is a standardized a measure of overactive bladder symptoms and health-related quality of life. The UDI Stress subscale has a range from 0 to 100 with higher scores indicating greater distress. The outcome is calculated as the difference in score at 3, 6, or 12 months and the score at baseline.

3.0
GroupValue95% CI
Botox A-27.9-37.7 – -18.1
Mid-Urethral Sling-46.4-55.4 – -37.3
6.0
GroupValue95% CI
Botox A-30.2-39.6 – -20.9
Mid-Urethral Sling-45.1-53.6 – -36.7
9.0
GroupValue95% CI
Botox A-20.2-30.1 – -10.4
Mid-Urethral Sling-42.3-53.1 – -31.4
12.0
GroupValue95% CI
Botox A-24.3-34.6 – -14.1
Mid-Urethral Sling-44.4-53.8 – -35.1
UDI-LF Irritative Score Change From Baseline Secondary · 3, 6, 9, and 12 Months

The Urogenital Distress Inventory is a standardized a measure of overactive bladder symptoms and health-related quality of life. The UDI Irritative subscale has a range from 0 to 100 with higher scores indicating greater distress. The outcome is calculated as the difference in score at 3, 6, or 12 months and the score at baseline.

3.0
GroupValue95% CI
Botox A-40.8-47.3 – -34.2
Mid-Urethral Sling-28.1-35.6 – -20.6
6.0
GroupValue95% CI
Botox A-35.8-43.3 – -28.3
Mid-Urethral Sling-30.6-37.4 – -23.8
9.0
GroupValue95% CI
Botox A-32.7-40.5 – -25
Mid-Urethral Sling-30.8-38.8 – -22.7
12.0
GroupValue95% CI
Botox A-31.6-39 – -24.2
Mid-Urethral Sling-33-41.4 – -24.6
UDI-LF Obstructive Score Change From Baseline Secondary · 3, 6, 9, and 12 Months

The Urogenital Distress Inventory is a standardized a measure of overactive bladder symptoms and health-related quality of life. The UDI Obstructive subscale has a range from 0 to 100 with higher scores indicating greater distress. The outcome is calculated as the difference in score at 3, 6, or 12 months and the score at baseline.

3.0
GroupValue95% CI
Botox A-13.5-18.8 – -8.1
Mid-Urethral Sling-10.1-14.6 – -5.7
6.0
GroupValue95% CI
Botox A-8.9-13.8 – -4
Mid-Urethral Sling-13.4-17.5 – -9.3
9.0
GroupValue95% CI
Botox A-10.2-15.7 – -4.7
Mid-Urethral Sling-12.6-17 – -8.2
12.0
GroupValue95% CI
Botox A-11.8-16.4 – -7.2
Mid-Urethral Sling-11.7-16.5 – -6.9
Average Daily Frequency of Combined Mixed Stress/Urge and Non-categorized Incontinence Epsiodes Change From Baseline Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries, average daily frequency of combined mixed stress/urge and non-categorized incontinence epsiodes. The outcome variable is computed as the difference in number of episodes at 3, 6, and 12 months and the number of episodes at baseline.

3.0
GroupValue95% CI
Botox A-0.4-0.90 – 0.00
Mid-Urethral Sling-0.4-0.90 – 0.10
6.0
GroupValue95% CI
Botox A-0.2-0.50 – 0.10
Mid-Urethral Sling-0.7-1.10 – -0.30
12.0
GroupValue95% CI
Botox A-0.2-0.60 – 0.20
Mid-Urethral Sling-0.7-1.30 – -0.20
Average Daily Frequency of All Incontinence Epsiodes Change From Baseline Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries, average daily frequency of all incontinence epsiodes. The outcome variable is computed as the difference in number of episodes at 3, 6, and 12 months and the number of episodes at baseline.

3.0
GroupValue95% CI
Botox A-4-4.90 – -3.20
Mid-Urethral Sling-3.9-5.00 – -2.80
6.0
GroupValue95% CI
Botox A-3.2-3.90 – -2.40
Mid-Urethral Sling-4.1-5.20 – -3.10
12.0
GroupValue95% CI
Botox A-3.6-4.70 – -2.60
Mid-Urethral Sling-4.5-5.80 – -3.20
Average Daily Frequency of Diurnal Voids Change From Baseline Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries, average daily frequency of diurnal voids. The outcome variable is computed as the difference in number of voids at 3, 6, and 12 months and the number of voids at baseline.

3.0
GroupValue95% CI
Botox A-1.2-1.70 – -0.70
Mid-Urethral Sling0-0.60 – 0.60
6.0
GroupValue95% CI
Botox A-0.8-1.30 – -0.20
Mid-Urethral Sling-0.2-0.90 – 0.60
12.0
GroupValue95% CI
Botox A-0.8-1.50 – -0.20
Mid-Urethral Sling-0.3-1.00 – 0.40
Average Daily Frequency of Nocturnal Voids Change From Baseline Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries, average daily frequency of nocturnal voids. The outcome variable is computed as the difference in number of voids at 3, 6, and 12 months and the number of voids at baseline.

3.0
GroupValue95% CI
Botox A-0.5-0.70 – -0.20
Mid-Urethral Sling-0.5-0.80 – -0.10
6.0
GroupValue95% CI
Botox A-0.3-0.60 – -0.10
Mid-Urethral Sling-0.2-0.50 – 0.20
12.0
GroupValue95% CI
Botox A-0.4-0.70 – -0.10
Mid-Urethral Sling-0.4-0.90 – 0.00
Average Daily Frequency of All Voids Change From Baseline Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries, average daily frequency of all voids. The outcome variable is computed as the difference in number of voids at 3, 6, and 12 months and the number of voids at baseline.

3.0
GroupValue95% CI
Botox A-1.6-2.20 – -1.00
Mid-Urethral Sling-0.4-1.10 – 0.20
6.0
GroupValue95% CI
Botox A-1.1-1.70 – -0.50
Mid-Urethral Sling-0.4-1.10 – 0.40
12.0
GroupValue95% CI
Botox A-1.2-2.00 – -0.50
Mid-Urethral Sling-0.7-1.60 – 0.10
Normalization of Voiding Frequency Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries at baseline and 3, 6, and 12 months, for participants with \>8 voids at baseline, the outcome is calculated as Yes=no more than 8 voids noted at the time point, No=Otherwise

3.0
GroupValue95% CI
Botox A17
Mid-Urethral Sling24
Botox A23
Mid-Urethral Sling13
6.0
GroupValue95% CI
Botox A17
Mid-Urethral Sling25
Botox A18
Mid-Urethral Sling10
12.0
GroupValue95% CI
Botox A13
Mid-Urethral Sling21
Botox A24
Mid-Urethral Sling12
Improvement of 50% or More in Voiding Frequency Post Baseline Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries at baseline and 3, 6, and 12 months, the outcome is calculated as Yes=at least 50% reduction in the number of voids between the timepoint and baseline, No=Otherwise

3.0
GroupValue95% CI
Botox A60
Mid-Urethral Sling61
Botox A1
Mid-Urethral Sling0
6.0
GroupValue95% CI
Botox A53
Mid-Urethral Sling59
Botox A0
Mid-Urethral Sling1
12.0
GroupValue95% CI
Botox A50
Mid-Urethral Sling54
Botox A3
Mid-Urethral Sling2
Worsening Voiding Frequency Post Baseline Secondary · 3, 6, and 12 Months

Based on data collected from participant-completed diaries at baseline and 3, 6, and 12 months, the outcome is calculated as Yes=greater than baseline number of voids at the time point or with greater than 8 voids at the time point, No=Otherwise

3.0
GroupValue95% CI
Botox A49
Mid-Urethral Sling39
Botox A12
Mid-Urethral Sling22
6.0
GroupValue95% CI
Botox A36
Mid-Urethral Sling32
Botox A17
Mid-Urethral Sling28
12.0
GroupValue95% CI
Botox A37
Mid-Urethral Sling34
Botox A16
Mid-Urethral Sling22

Adverse events — posted to ClinicalTrials.gov

Time frame: 12 Months. Reporting threshold: 0.00%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Botox A
Serious: 3/71 (4%)
Deaths: 0/71
Mid-Urethral Sling
Serious: 8/69 (12%)
Deaths: 0/69

Serious adverse events (15 terms)

ReactionSystemBotox AMid-Urethral Sling
Cardiac failureCardiac disorders
Cardiac failure congestiveCardiac disorders
Myocardial infarctionCardiac disorders
Ventricular extrasystolesCardiac disorders
Chronic sinusitisInfections and infestations
PyelonephritisInfections and infestations
ObesityMetabolism and nutrition disorders
ArthralgiaMusculoskeletal and connective tissue disorders
OsteoarthritisMusculoskeletal and connective tissue disorders
Spinal stenosisMusculoskeletal and connective tissue disorders
Ischaemic strokeNervous system disorders
SyncopeNervous system disorders
Acute kidney injuryRenal and urinary disorders
Chronic obstructive pulmonary diseaseRespiratory, thoracic and mediastinal disorders
Tonsillar hypertrophyRespiratory, thoracic and mediastinal disorders
Other adverse events (74 terms — click to expand)

ReactionSystemBotox AMid-Urethral Sling
Urinary tract infectionInfections and infestations
Urinary retentionRenal and urinary disorders
Coronavirus infectionInfections and infestations
Residual urine volumeInvestigations
ConstipationGastrointestinal disorders
Medical device site erosionGeneral disorders
Suprapubic painGeneral disorders
CellulitisInfections and infestations
Ear infectionInfections and infestations
SinusitisInfections and infestations
Vulvovaginal mycotic infectionInfections and infestations
ArthralgiaMusculoskeletal and connective tissue disorders
Pelvic discomfortReproductive system and breast disorders
Lichen sclerosusSkin and subcutaneous tissue disorders
Atrial fibrillationCardiac disorders
Ear painEar and labyrinth disorders
Abdominal painGastrointestinal disorders
Defaecation urgencyGastrointestinal disorders
DiarrhoeaGastrointestinal disorders
DyscheziaGastrointestinal disorders
Gastrooesophageal reflux diseaseGastrointestinal disorders
Levator syndromeGastrointestinal disorders
Adverse drug reactionGeneral disorders
Chest painGeneral disorders
FatigueGeneral disorders
OedemaGeneral disorders
Oedema peripheralGeneral disorders
Multiple allergiesImmune system disorders
Fungal skin infectionInfections and infestations
GastroenteritisInfections and infestations
Gonococcal pelvic inflammatory diseaseInfections and infestations
LaryngitisInfections and infestations
Otitis externa fungalInfections and infestations
PharyngitisInfections and infestations
PyelonephritisInfections and infestations
Skin candidaInfections and infestations
Upper respiratory tract infectionInfections and infestations
ContusionInjury, poisoning and procedural complications
FallInjury, poisoning and procedural complications
Ligament ruptureInjury, poisoning and procedural complications

Most-reported serious reactions: Cardiac failure, Cardiac failure congestive, Myocardial infarction, Ventricular extrasystoles, Chronic sinusitis, Pyelonephritis, Obesity, Arthralgia.

Data from ClinicalTrials.gov NCT04171531 adverse events section.

Sponsor's own description

The primary aim is to compare the effectiveness of intradetrusor injection of 100 unit injection of Botulinum toxin A to mid-urethral sling for change in MUI symptoms 6 months following treatment.

Publications & conference data

3 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Midurethral Sling vs OnabotulinumtoxinA in Females With Urinary Incontinence: The MUSA Randomized Clinical Trial.
    Harvie HS, Menefee SA, Richter HE, Sung VW, et al · · 2025 · cited 4× · PMID 40323617 · DOI 10.1001/jama.2025.4682
  2. Cost-effectiveness of behavioral and pelvic floor muscle therapy combined with midurethral sling surgery vs surgery alone among women with mixed urinary incontinence: results of the Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence randomized tri
    Harvie HS, Sung VW, Neuwahl SJ, Honeycutt AA, et al · · 2021 · cited 4× · PMID 34242627 · DOI 10.1016/j.ajog.2021.06.099
  3. Trial Design for Mixed Urinary Incontinence: Midurethral Sling Versus Botulinum Toxin A.
    Harvie HS, Richter HE, Sung VW, Chermansky CJ, et al · · 2024 · cited 2× · PMID 38212101 · DOI 10.1097/spv.0000000000001422

Verify or expand the search:

Other trials of Botox® injection

Trials testing the same drug.

Other recruiting trials for Urinary Incontinence, Stress

Currently open trials in the same condition.

Other NICHD Pelvic Floor Disorders Network trials

Trials by the same sponsor.

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Data sources for this page

Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT04171531.

Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing