Login to Access Video or Poster Abstract: MP40-15
Sources of Funding: None

Introduction

Overactive bladder (OAB) impacts over 15% of the population over the age of 40. A recent review by Veenboer showed the median persistence rates for anticholinergic medications was 12-39% at one year, due either to minimal success or intolerable side effects. The introduction of third line therapies for OAB, including sacral neuromodulation, posterior tibial nerve stimulation, and intradetrusor injection of onabotulinumtoxinA, has improved the success rates for treatment of OAB. Despite availability of effective therapy for OAB, many patients do not receive optimal treatment. Here we examine the practice patterns and utilization of third line treatment in a tertiary referral center with expertise in female pelvic medicine and reconstructive surgery (FPMRS).

Methods

The electronic medical record was queried for all patients seen for OAB, from October 1, 2015 to September 30, 2016. Patients with a diagnosis of neurogenic bladder or BPH with obstruction were excluded. The number of visits associated with an OAB prescription and the number of patients who received third line therapy were determined and subcategorized by department, with FPMRS providers considered separately.

Results

4,435 patients were seen for a total of 7,015 visits for OAB. 37% were seen in the urology department and 27% were seen by FPMRS providers. 30% of patients seen by urologists had an OAB prescription associated with their visit, compared with 16.6% of those seen in the institution as a whole. Of all the patients seen for OAB, 4.5% received third line therapy, compared with 11.7% and 15.8% of those seen in urology and by FPMRS providers, respectively.

Conclusions

Use of third line therapy for OAB has been reported to be less than 5%. This rate is higher at our institution, likely due to access to multiple FPMRS providers. The authors also use a care pathway that emphasizes early patient education on available options should they fail first and second line treatments. Even in a tertiary referral center it is likely that third line therapy is not being offered to many patients who would benefit from it. Our data demonstrate an opportunity for urologists to improve the quality of care and treatment success rates for OAB patients.

Funding

None