Related Experiment Video
Updated: Aug 6, 2025
Nerve-sparing Mid-urethral Obstruction NeMO in Female Small Rodents
Published on: April 25, 2017
Urologist-perceived barriers and perspectives on the underuse of sacral neuromodulation for overactive bladder in
Peter Gariscsak1, Gary Gray2, Stephen Steele3
1School of Medicine, Queen's University, Kingston, ON, Canada.
Introduction:
An estimated 18% of Canadians have overactive bladder (OAB), with approximately 24% of those reporting difficulty adhering to pharmacotherapy. To date, there has been no investigation into barriers facing sacral neuromodulation (SNM) as treatment for OAB in Canada.
Methods:
Current Canadian Urological Association members were invited to participate in an anonymous survey. Data collected included open-ended and Likert scale responses addressing barriers to referral for SNM. Qualitative analysis used a Theoretical Domains Framework (TDF), while quantitative responses are reported using descriptive statistics.
Results:
A response rate of 20.4% (n=142) was obtained. Most respondents believed SNM was underused (n=82, 57.7%) compared to only 6.3% (n=9) who believed it was used adequately. The most commonly cited reasons for not offering SNM were lack of availability (n=85, 59.9%), expertise (n=49, 34.5%), and funding (n=26, 18.3%). Participants were neutral regarding confidence to appropriately recommend SNM to patients (median 3, interquartile range [IQR] 2-4) and were not confident to manage patient care and issues related to SNM devices (median 2, IQR 1-3). On thematic analysis using the TDF, the most prevalent barriers to SNM care were related to infrastructure and resources. A lack of trained experts and lack of knowledge related to SNM use were also commonly identified barriers.
Conclusions:
In this first study exploring urologist-perceived barriers to SNM referral for medically refractory OAB in Canada, urologists acknowledge that SNM implantation is underused but did not feel confident in recommending SNM appropriately. A lack of trained experts and poor funding were also identified as major barriers to SNM referral.
Insights
Canadian urologists find sacral neuromodulation (SNM) for overactive bladder (OAB) is underused due to lack of availability, expertise, and funding. They lack confidence in recommending and managing SNM, highlighting infrastructure and resource barriers.
Area of Science:
- Urology
- Medical Devices
- Patient Care
Background:
- Overactive bladder (OAB) affects 18% of Canadians, with many facing challenges with current treatments.
- Sacral neuromodulation (SNM) is an option for refractory OAB, but its use in Canada is not well understood.
- Pharmacotherapy adherence is a significant issue for OAB patients.
Purpose of the Study:
- To investigate the barriers perceived by Canadian urologists regarding sacral neuromodulation (SNM) for overactive bladder (OAB).
- To identify factors limiting SNM referral and utilization in Canada.
- To understand urologist confidence levels in recommending and managing SNM.
Main Methods:
- Anonymous survey distributed to current Canadian Urological Association members.
- Collected both open-ended and Likert scale responses on SNM referral barriers.
- Qualitative analysis using the Theoretical Domains Framework (TDF) and quantitative descriptive statistics.
Main Results:
- A 20.4% response rate (n=142) indicated a strong belief that SNM is underused.
- Key barriers identified include lack of availability (59.9%), expertise (34.5%), and funding (18.3%).
- Urologists reported low confidence in recommending and managing SNM, with infrastructure and resources cited as primary obstacles.
Conclusions:
- This study is the first to explore urologist-perceived barriers to SNM referral for OAB in Canada.
- Urologists recognize SNM is underused but lack confidence in its appropriate recommendation and management.
- Lack of trained experts and inadequate funding are significant barriers to SNM adoption.
Related Concept Videos
01:19Urodynamic Studies: Uroflowmetry
01:30Urinary Tract Calculi III: Medical Management
01:21Nursing Assessment of the Genitourinary System I: Health History
01:23Urinary Bladder
In males, the bladder is situated in front of the rectum, while in females, it is positioned anterior to the vagina and uterus. The bladder floor contains an inverted triangular area called the trigone, defined by the two ureteric...
01:25Urinary Tract Calculi VI: Surgical Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations