A new study suggests that a significant number of overactive bladder (OAB) patients who are candidates for advanced therapy are not receiving it.
Data presented at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction winter meeting in Austin, TX indicated that a majority of OAB patients discontinue pharmacotherapy long-term despite chronic symptoms. In addition, even though advanced therapy is part of the clinical care pathway for refractory OAB, the retention rate even in a urology clinic is exceedingly low, according to the authors.
The investigators conducted a retrospective review at a single academic hospital system and analyzed all new outpatient encounters between Aug. 1, 2014 and Aug. 1, 2015. All the patients had a diagnosis of OAB (wet or dry). The authors looked at the number of subsequent visits for each OAB patient and which patients received advanced therapy during the study period. The team conducted a separate analysis of patients seen and cared for only by urologists.
“I was surprised by how few patients within an academic urology practice were progressing to advanced therapies. Urologists should care about our findings as they illuminate areas of potential improvement in the care of patients with OAB,” said study investigator Siobhan Hartigan, MD, of the University of Pennsylvania, Philadelphia, working with William Jaffe, MD, and colleagues.
Dr. Hartigan, who presented the study findings at the meeting, said tolerance and long-term adherence to pharmacotherapy in OAB patients are exceedingly poor. Studies suggest that only 12% to 39% of OAB patients continue with their medications at 12 months. After patients fail these medications, they are often falling through the cracks.
Dr. Hartigan said the next step in treatment is advanced therapy, which includes posterior tibial nerve stimulation (PTNS), sacral neuromodulation (SNM), or chemodenervation. Even though the majority of patients discontinue pharmacotherapy or are unsatisfied with their treatment, they appear to be lost to follow-up. The authors analyzed the attrition rate for 17,041 patients with OAB based on the percentages of patients receiving PTNS, SNM, or chemodenervation.