Minimally invasive overactive bladder (OAB) therapies (percutaneous tibial nerve stimulation [PTNS], onabotulinumtoxinA [BTX], sacral neuromodulation [SNM]) are commonly used in older adults, however little is known regarding utilization of more than one minimally invasive OAB therapy within 2 years of initiating such treatment.
This retrospective cohort study included 100% of fee-for-service Medicare beneficiaries who underwent minimally invasive OAB therapy (MIT) from 2015 to 2020. The primary outcome was initiation of a different MIT within 2 years of the index therapy. A Sankey diagram was created to visualize the sequence and flow of therapies. Multivariable modified Poisson regression was performed to identify patient-factors associated with initiating different MIT.
Among the 111,939 beneficiaries undergoing first-time MIT, 18,444 (16.5%) initiated different MIT within 2 years. The most common pattern was PTNS followed by BTX (29.1%), then BTX followed by SNM (20.9%) and SNM followed by BTX (20.0%). Factors associated with increased likelihood of initiating different MIT were: PTNS as the index therapy (aRR 1.43, 95% CI 1.38-1.48 vs. SNM), female sex (aRR 1.12, 95% CI 1.09-1.16), and higher frailty levels (pre-frail aRR 1.09, 95% CI 1.06-1.13; mild-to-severe frailty aRR 1.08, 95% CI 1.03-1.14 vs. not frail). Older age (75-84 aRR 0.88, 95% CI 0.86-0.91; ≥ 85 aRR 0.60, 95% CI 0.57-0.63 vs. 65-74 years) and non-White race (aRR 0.79, 95% CI 0.75-0.84) were associated with lower likelihood of initiating different MIT.
Among Medicare beneficiaries receiving MIT, 16.5% initiated different therapy within 2 years. These high rates of more than one MIT within a short time endorse the need for expectation-setting and close follow-up.
Neurourology and urodynamics. 2025 Nov 12 [Epub ahead of print]
Abigail Shatkin-Margolis, Adam Crow, Lufan Wang, Unwanaobong Nseyo, Louise Walter, Kenneth Covinsky, W John Boscardin, Anne M Suskind
Department of Obstetrics and Gynecology, University of California, San Francisco, California, USA., University of California Davis School of Medicine, Sacramento, California, USA., Department of Urology, University of California, San Francisco, California, USA., Department of Urology, Weill Cornell Medical Center, New York, New York, USA., Division of Geriatrics, University of California, San Francisco, California, USA., Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.