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SUFU 2022: Patient Preference of Third Line Therapy for Overactive Bladder

(UroToday.com) Third-line therapies, including intradetrusor onabotulinumtoxinA (Botox), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM), are indicated for patients with overactive bladder (OAB) who are refractory to first- and second-line therapies. This study sought to investigate specific reasons for patient preference of each third-line OAB therapy.


A prospective cohort of patients (n=85) eligible for third-line OAB therapies watched an educational video providing information on the risks/benefits of each treatment option. They were asked to rank their preferences and the reasons they felt each therapy was most and least attractive. Patients <18 years old, non-English speakers, and those with developmental disabilities were excluded.

Eleven patients (13%) did not prefer any third-line therapy. The following ranked each respective therapy as their first preference on the questionnaire:
  • 32 Botox (38%), more patients age ≥ 65 ranked Botox as their first preference (p=0.003), the most attractive feature was potential for long-lasting efficacy (48%); the least attractive feature was the risk of self-catheterization for urinary retention (52%).
  • 31 PTNS (37%), more patients ages 18-64 ranking PTNS as their first preference (p=0.044). Most attractive features were: 1) no reported significant complications (36%) and 2) no need for surgery (35%); least attractive feature was the need for frequent office visits (59%).
  • 11 SNM (13%) The most attractive feature of SNM was the potential for long-term relief without frequent office visits (54%); the least attractive feature was need for an implanted device (29%).

Education level and income did not appear to play a significant role.

The authors concluded that patients age ≥ 65 appear to prefer Botox, perhaps due to its long duration of efficacy and infrequent follow-up required; those ages 18-64 appear to prefer PTNS, possibly due to avoidance of surgery and low complication rate. Clinicians may benefit from this data when counseling patients about third-line OAB treatment.

Presented by: Anjali Kapur, MD,1 Tal Cohen, MD,1 Colin Dabrowski, MD,2 Rebecca Andersen, MD,2 Kuemin Hwang, BS,2 Edwin Lee, BS,2 Heng Ruan, BA,3 Steven Weissbart, MD,1 Jason Kim, MD1

  1. Stony Brook Urology
  2. Stony Brook Medicine
  3. Stony Brook University

Written by: Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health at the 2022 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting, February 22 - 26, 2022