Patterns of Care Following Procedural Intervention Among Women With Overactive Bladder.

Area of Science:

• Urology
• Female Pelvic Medicine
• Neourology

Background:

• Overactive bladder (OAB) is commonly treated with intradetrusor onabotulinumtoxinA (BTX), sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS).
• Real-world data on treatment continuation and crossover patterns among these OAB therapies are limited.
• Understanding longitudinal outcomes is crucial for effective patient management.

Purpose of the Study:

• To evaluate long-term treatment continuation rates for procedural OAB therapies.
• To assess therapy crossover patterns between BTX, SNM, and PTNS in women.
• To provide data for informed patient counseling and treatment selection.

Main Methods:

• Retrospective, multi-institutional cohort study of women with idiopathic OAB.
• Inclusion of patients undergoing index BTX, SNM, or PTNS between 2014 and 2022.
• Kaplan-Meier survival analysis for treatment continuation and log-rank test for crossover rates.

Main Results:

• Percutaneous tibial nerve stimulation (PTNS) had the lowest ongoing treatment rates (17.1% at 3-5 years) and highest crossover (26.1% within 3 years).
• OnabotulinumtoxinA (BTX) showed 65.2% repeat treatment within 3 years and 9.5% crossover.
• Sacral neuromodulation (SNM) had 13.1% crossover within 3 years, mostly to BTX, with low revision rates.

Conclusions:

• PTNS demonstrates lower therapy persistence and higher crossover rates compared to BTX and SNM.
• BTX and SNM exhibit comparable crossover rates, highlighting the need for individualized treatment selection.
• Findings emphasize tailoring OAB treatment based on patient expectations and exploring strategies for improved adherence and novel therapeutic approaches.