Limited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation.
To describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year.
The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up.
Among 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score.
Treatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated.
Neurourology and urodynamics. 2022 Oct 23 [Epub]
Carol Emi Bretschneider, Qian Liu, Abigail R Smith, Ziya Kirkali, Cindy L Amundsen, Henry Lai, Juila Geynisman-Tan, Anna Kirby, Anne P Cameron, Margaret E Helmuth, James W Griffith, John Eric Jelovsek, Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort Study Group
Northwestern University-The Feinberg School of Medicine, Chicago, Illinois, USA., Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA., Duke University Medical Center, Durham, North Carolina, USA., Departments of Surgery and Anesthesiology, Division of Urologic Surgery, Washington University School of Medicine, St Louis, Missouri, USA., University of Washington Medical Center, Seattle, Washington, USA., University of Michigan, Ann Arbor, Michigan, USA.