Shifts in patient preference of third‐line overactive bladder therapy after introduction of the implantable tibial nerve stimulator

• Published in: Neurourology and urodynamics 2024-04, Vol.43 (4), p.959-966
• Main Authors: Kapur, Anjali, Aalami Harandi, Arshia, Hartman‐Kenzler, Jacob, Kim, Jason
• Format: Article
• Language: English
• Subjects: Comorbidity; implantable tibial nerve stimulation; Neuromodulation; overactive bladder; Patients; Phenotypes; Preferences; Surveys; third‐line therapies; Tibial nerve; Urinary incontinence
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.25421

Introduction Third‐line therapies for overactive bladder (OAB) that are currently recommended include intravesical Onabotulinumtoxin‐A injections (BTX‐A), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The implantable tibial nerve stimulator (ITNS) is a novel therapy that is now available to patients with OAB. Objective The objective of this study was to analyze shifts in patient preference of third‐line therapies for OAB after introducing ITNS as an option among the previously established therapies for non‐neurogenic OAB. Methods A survey was designed and distributed via SurveyMonkey to the platform's audience of U.S. adults of age 18 and older. Screening questions were asked to include only subjects who reported symptoms of OAB. Descriptions of current AUA/SUFU guideline‐approved third‐line therapies (BTX‐A, PTNS, and SNM) were provided, and participants were asked to rank these therapies in order of preference (stage A). Subsequently, ITNS was introduced with a description, and participants were then asked to rank their preferences amongst current guideline‐approved therapies and ITNS (stage B). Absolute and relative changes in therapy preferences between stage A and stage B were calculated. Associations between ultimate therapy choice in stage B and participant characteristics were analyzed. Results A total of 485 participants completed the survey (62.5% female). The mean age was 49.1 ± 36.5 years (SD). The most common OAB symptoms reported were urgency urinary incontinence (UUI) (73.0%) and urinary urgency (68.0%). 29.2% of patients had tried medication for OAB in the past, and 8.0%–10.3% of patients were previously treated with a third‐line therapy for OAB. In stage A, participants ranked their first choice of third‐line therapy as follows: 28% BTX‐A, 27% PTNS, and 13.8% SNM. 26.6% of participants chose no therapy, and 4.5% chose all three equally. In stage B, participants ranked their first choice as follows: 27.6% BTX‐A, 19.2% PTNS, 7.8% SNM, and 19.2% ITNS. 21.9% of participants chose no therapy and 4.3% chose all four equally as their first choice. There were both absolute and relative declines in proportions of patients interested in BTX‐A, SNM, and PTNS as their first choice of third‐line therapy with the introduction of ITNS. Patients originally interested in PTNS in stage A had the greatest absolute change after the introduction of ITNS with 7.8% of participants opting for ITNS in stage B. Those interested in