National trends in neuromodulation for urinary incontinence among insured adult women and men, 2004-2013: the Urologic Diseases in America Project.

To examine US trends in neuromodulation for urinary incontinence (UI) treatment from 2004-2013.

This study utilized two data sources: the Optum© de-identified Clinformatics® Data Mart Database for privately insured adults aged 18-64 years with a UI diagnosis (N≈40,000 women and men annually) and the Medicare 5% Sample for beneficiaries aged ≥65 years with a UI diagnosis (N≈65,000 women and men annually). We created annual cross-sectional cohorts and assessed prevalence of UI-related neuromodulation procedures among men and women separately from 2004-2013. Analyses were conducted overall and stratified by age, race/ethnicity, and geographic region.

Nearly all neuromodulation procedures occurred in outpatient settings. Sacral neuromodulation (SNM) procedures for UI in both women and men grew steadily from 2004-2013, with more procedures performed in women than men. Among women with UI, SNM prevalence grew from 0.1-0.2% in 2004 to 0.5-0.6% in 2013. Posterior tibial nerve stimulation (PTNS) experienced growth from 2011-2013. Chemodenervation of the bladder with onabotulinumtoxinA (BTX) combined with other injectable procedures (including urethral bulking) remained stable over time.

From 2004-2013, SNM procedures remained relatively uncommon but increased consistently. PTNS experienced growth starting in 2011 when PTNS-specific insurance claims became available. BTX trends remain unclear; future studies should assess it separately from other injectable procedures. Neuromodulation has a growing role in UI treatment, and ongoing trends will be important to examine.

Urology. 2020 Dec 06 [Epub ahead of print]

Una J Lee, Julia B Ward, Lydia Feinstein, Brian R Matlaga, Erline Martinez-Miller, Tamara Bavendam, Ziya Kirkali, Kathleen C Kobashi, Urologic Diseases in America Project

Section of Urology, Virginia Mason Medical Center, Seattle, WA. Electronic address: ., Social & Scientific Systems, Durham, NC. Electronic address: ., Social & Scientific Systems, Durham, NC. Electronic address: ., Johns Hopkins Brady Urological Institute, Department of Urology, Baltimore, MD. Electronic address: ., Social & Scientific Systems, Durham, NC. Electronic address: ., National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. Electronic address: ., National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD. Electronic address: ., Section of Urology, Virginia Mason Medical Center, Seattle, WA. Electronic address: .