Many OAB patients not receiving advanced therapy

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.The study showed that 67.33% did not have a second visit. The investigators found that urology providers saw a total of 4,735 OAB patients and only 1,473 (31.11%) had a second visit. Even more concerning was the fact that there was an 87.18% dropout rate by the third visit. Among all urology patients with OAB, there were 128 patients (2.7%) who underwent any advanced therapy within the study period. Among these patients, 33 patients had PTNS, 49 had SNM, and 49 had chemodenervation. The study showed that three patients underwent ≥2 of these treatments.

Dr. Hartigan said there has been a lot of discussion in recent years about incorporating patient navigators into a urology practice, particularly in a private practice setting, for OAB patients. In addition, SUFU recently released its clinical care pathway for OAB to help patients and providers move along the pathway to receive adequate treatment for OAB. The goal of this current investigation was to explore the attrition rate and progression to advanced therapy for patients with OAB within a large academic institution and to see if the numbers were better, worse, or about the same as compared to private practice.

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“I think the most important take-home message is that there is a large amount of room for improvement here. Based on previously published studies regarding adherence to pharmacotherapy for OAB, one can extrapolate from our results that the majority of patients are not being adequately treated for their OAB,” Dr. Hartigan told Urology Times.

Dr. Hartigan said providers in general, and especially urologists, can improve their care of OAB patients by having a structure in place of ensuring return office visits and progressing patients down the clinical care pathway for OAB.

“We have excellent treatments for OAB, but if patients are lost to follow-up or are not informed or offered advanced therapies when indicated, then we are doing our patients a great disservice. It is important to recognize that high attrition rates and low progression to advanced therapy exist in both a private practice and academic setting,” Dr. Hartigan said.