Trends in Reported Case Logs of OnabotulinumtoxinA and Sacral Neuromodulation

We investigated current trends in reported case logs of third line treatments for primarily overactive bladder including sacral neuromodulation, percutaneous tibial nerve stimulation and chemodenervation.

Data on third line overactive bladder procedure volume was obtained from the American Board of Urology annualized case logs between 2010 and 2016. Entries from certifying, recertifying, and female pelvic medicine and reconstructive surgery applying urologists were considered. Statistical analysis was then performed to identify trends and surgeon characteristics that predicted the number of procedures performed.

Case log reported procedures of third line therapies increased from 1,822 in 2010 to a peak of 6,143 in 2013. From 2010 to 2016, 25% (1,375/5,499) of all urologists logged at least 1 chemodenervation or neuromodulation procedure, while only 2 urologists logged percutaneous tibial nerve stimulation cases. In total, 26,874 neuromodulation or chemodenervation procedures were logged. Neuromodulation usage peaked in 2013, the year of U.S. Food and Drug Administration approval for chemodenervation, and has since been declining. Chemodenervation procedures increased each year after 2013 until declining in 2016. Female pelvic medicine and reconstructive surgery surgeons performed significantly more procedures than all other specialty categories (p ≤0.01). Gender, practice region, practice size and practice setting were also significant predictors of the number of procedures performed.

Chemodenervation and neuromodulation have increased considerably in the past 6 years. There are differences in the types of procedures being performed based on gender, subspecialty, certification status, practice region, practice size and practice setting.