Retrospective study suggests differences in OAB therapy persistence among older adults

In this interview, conducted at the 2026 American Urological Association Annual Meeting, Unwanaobong Nseyo, MD, MHS, discusses a retrospective analysis comparing treatment continuation outcomes among older adults receiving treatment with minimally invasive therapies for idiopathic overactive bladder (OAB). Overall, the study found that patients were most likely to continue treatment with onabotulinumtoxinA (BTX-A) and least likely to continue percutaneous tibial nerve stimulation (PTNS) over 2 years of follow-up.¹

Nseyo is an assistant professor of urology at Weill Cornell Medicine in New York, New York.

Nseyo explained that the study was designed in response to evolving treatment paradigms for OAB, particularly following updates to the AUA/SUFU guidelines that emphasize shared decision-making rather than a stepwise escalation of therapy. Given the limitations and adverse effects associated with OAB pharmacotherapy in older adults, the investigators sought to compare real-world outcomes among minimally invasive therapies and determine how these options perform in a Medicare population. The study specifically examined treatment continuation as a proxy for therapeutic benefit, addressing an important evidence gap regarding comparative effectiveness in older adults.

Using a 100% sample of fee-for-service Medicare beneficiaries treated for idiopathic OAB between 2015 and 2020, the investigators conducted a retrospective cohort study evaluating BTX-A, sacral neuromodulation (SNM), and PTNS. Therapy-specific definitions of continuation were developed to reflect the iterative nature of each treatment modality. For BTX-A, continuation was defined as at least 1 repeat injection within 2 years; for SNM, progression to an implantable pulse generator within 90 days without explantation by 2 years; and for PTNS, completion of induction therapy followed by maintenance treatments. Propensity score weighting and modified Poisson regression were used to compare outcomes across treatment groups.

Among 111,494 Medicare beneficiaries who initiated minimally invasive OAB therapy, 34.5% continued treatment over 2 years. Continuation rates were highest for BTX-A (58%), followed by SNM (36.3%) and PTNS (9.9%). Weighted analyses showed that patients receiving BTX-A were 5.9 times (95% CI, 5.71 to 6.10) more likely to continue therapy than those receiving PTNS and 1.63 times (95% CI, 1.60 to 1.65) more likely to continue therapy than those receiving SNM. Patients undergoing SNM were 3.63 times (95% CI, 3.57 to 3.68) more likely to continue treatment than those receiving PTNS.

REFERENCE

1. Nseyo U, Zuo S, Wang L, et al. IP16-22: COMPARATIVE OUTCOMES FOR MINIMALLY INVASIVE THERAPIES FOR IDIOPATHIC OVERACTIVE BLADDER IN OLDER ADULTS: A NATIONAL STUDY OF MEDICARE BENEFICIARIES. J Urol. 2026;215(5S):e342. doi:10.1097/01.JU.0001191360.00345.d8.22