Use of Third Line Therapy for Overactive Bladder in a Practice with Multiple Subspecialty Providers: Are we doing enough?

Overactive bladder (OAB) impacts over 15% of the adult population. Compliance with medical treatment is low, due either to inadequate symptom control or intolerable side effects. Although third line therapies have improved the treatment of OAB, many patients do not receive optimal treatment.

We hypothesize that the utilization of third line treatment is higher among female pelvic medicine and reconstructive surgery urologists and examine its use in our tertiary referral center.

The electronic medical record was queried for OAB patients seen over one year. The number of visits associated with an OAB prescription and the number of patients who received third line therapy were determined and subcategorized by department, with FPMRS providers considered separately.

5,445 patients were seen for 8,994 visits for OAB. Of all the patients seen for OAB, 3.5% received third line therapy, compared with 10.0% and 14.1% of those seen by urology and by FPMRS providers.

Use of third line therapy has been reported to be less than 5%. This rate is higher at our institution, likely due to multiple FPMRS providers. The authors also use an algorithm that facilitates patient education on available options should they fail first and second line treatments. Given the limited compliance with medical treatment for OAB, we are likely missing a segment of the patient population who would benefit from third line treatment. Our data demonstrate an opportunity for urologists to improve the quality of OAB treatment, and subsequently improve their patients' quality of life.

The Journal of urology. 2017 Sep 28 [Epub ahead of print]

Dena Moskowitz, Sarah A Adelstein, Alvaro Lucioni, Una J Lee, Kathleen C Kobashi

Virginia Mason Medical Center, Section of Urology and Renal Transplantation. Electronic address: ., Virginia Mason Medical Center, Section of Urology and Renal Transplantation. Electronic address: ., Virginia Mason Medical Center, Section of Urology and Renal Transplantation. Electronic address: ., Virginia Mason Medical Center, Section of Urology and Renal Transplantation. Electronic address: ., Virginia Mason Medical Center, Section of Urology and Renal Transplantation. Electronic address: .

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