Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registry

Minimally invasive therapies (MITs) for overactive bladder (OAB) are effective for patients who have failed or cannot tolerate medical management. Despite this, rates of MIT are low and have remained stagnant. Using the AQUA database, we examine trends in utilization of MIT over time with a focus on patient and provider factors that affect selection of sacral neuromodulation (SNM) over other MITs for OAB.

The AQUA Registry was queried for adults with idiopathic OAB who received MIT from 2014 to 2023. Patients were analyzed by age, race, sex, insurance, and MIT trends over time. Multivariable logistic regression was used to evaluate patient and provider factors associated with SNM selection.

Of 2,006,684 patients with idiopathic OAB, 58,840 (2.9%) received MIT; 19,582 (0.98%) SNM; 28,463 (1.4%) bladder onabotulinum toxin injection (BTX-A); and 17,045 (0.85%) percutaneous tibial nerve stimulation. There was an increase in those undergoing BTX-A and a decline in those undergoing SNM and percutaneous tibial nerve stimulation over time. Patients receiving SNM vs other MITs were more likely to be younger than 51 years, male, in a rural area, and seen in a high-volume OAB practice. Patients in the Southeastern and South Central sections were more likely to receive SNM.

Overall utilization of MIT was 2.9% over a 9-year period. While SNM has seen a decline in relative utilization compared with BTX-A, overall MIT use has stayed stagnant. Patient and provider demographics impact choice of SNM over other MITs. These findings highlight an opportunity to better understand trends and limitations when providing MITs.