Availability, expertise, and funding were the primary issues identified as barriers to use of sacral neuromodulation for the treatment of patients with overactive bladder.
Urologists believe that sacral neuromodulation (SNM) is underused for the treatment of patients with overactive bladder (OAB) and the key usage barriers are availability, expertise, and funding, according to a recently published Canadian study.1
The study findings were obtained through a survey of 142 Canadian urologists. Overall, 57.7% (n = 82) of those surveyed considered SNM to be underused for OAB, with only 9 (6.3%) respondents considering the treatment to be used at the appropriate frequency. An additional 35.2% (n = 50) were unsure whether SNM was appropriately utilized, with no urologists reporting that it was overutilized.
When asked about barriers to offering SNM, 59.9% (n = 85) cited lack of availability, 34.5% (n = 49) listed lack of expertise, and 18.3% (n = 26) cited lack of funding.
“We recommend improved training and continuing education on how and why patients may benefit from SNM, as well as indications for appropriate referral,” the authors wrote in proposing solutions to their findings.
For their study, the investigators emailed their survey to all registered Canadian urologists in the Canadian Urological Association’s member’s-only available database. There was a 21-day response period for the survey lasting from October 14 to November 3, 2021.
Of the urologists who responded to the survey, 46.5% were aged <40 years, 28.9% were aged 40 to 49 years, and 24.7% were aged 50 to 70+ years. About 55% of patients practiced in academic centers and about 45% practiced in the community setting. Regarding size of practice, 14.1% had a solo practice, 39.4% practiced in a group of 2 to 5 urologists, and 46.5% practiced in a group of more than 5 urologists. The median number of years in practice following residency was 11.69.
The most common prior experiences with SNM among respondents were having referred patients for SNM implantation evaluation (35.2%; n = 50) and being aware of SNM but having no experience with implantation or patient care (33.1%; n=47). None of the respondents reported that they were unaware of SNM.
“Our results support the need for physician champions of care as well as institutional and governmental support through increased funding and resources to increase SNM uptake,” the investigators wrote in their conclusion.
1. Gariscsak P, Gray G, Steele S, et al. Urologist-perceived barriers and perspectives on the underuse of sacral neuromodulation for overactive bladder in Canada [published online ahead of print March 20, 2023]. Can Urol Assoc J. 2023. doi: 10.5489/cuaj.8176