Overactive bladder (OAB) medications often have poor tolerability or lack of efficacy with many progressing to 3 line therapy, such as sacral neuromodulation (SNM). Use of SNM may avoid the potential side effects of OAB medications, while achieving symptom improvement. We evaluated the post-operative rate of discontinuing OAB medications in patients who underwent SNM for refractory OAB.
A query of a prospectively-collected institutional review board- approved database for patients who underwent SNM was performed. Patients were excluded if surgical indication was urinary retention or if SNM device was removed ≤1-year post-operatively. We assessed clinical characteristics, urodynamic parameters, and filled OAB medications by an external prescription database. Patient-perceived post-operative outcomes were examined. Groups were compared using Student's t-test and Chi-squared test.
Of the 78 patients who met inclusion criteria, 82.1% stopped and never restarted OAB medications (SNM only). 14.1% of patients consecutively continued filling of OAB medications at ≥1 year following surgery (concurrent). There was no difference between groups regarding BMI, gender, SNM revision, urodynamic parameters, Patient Global Impression of Improvement (PGI-I), or patient-perceived percent improvement, but concurrent patients were significantly older than SNM only patients (p=0.002).
>80% of patients who progressed to SNM discontinued OAB medications and utilized SNM as their sole treatment. A small portion of patients concurrently used OAB medications following SNM for ≥1 year, however outcomes were similar between groups. SNM presents as a strategy to provide refractory patients with a successful outcome yet avoid potentially detrimental side effects related to OAB medications.
The Journal of urology. 2019 Jan 25 [Epub ahead of print]
Katherine Amin, Dena Moskowitz, Kathleen C Kobashi, Una J Lee, Alvaro Lucioni