Why do patients prefer some OAB third-line therapies over others?

Urology Times Journal, Vol 50 No 03, Volume 50, Issue 03

In a recent study, which will be presented at the 2022 Society of Women in Urology Annual Clinical Mentoring Conference, a team of investigators analyzed factors that influence patients when choosing third-line treatments for overactive bladder (OAB).1

“Patients are overwhelmed by these choices often, and don't really understand the risks and benefits when they're first told about them,” said co-author Anjali Kapur, MD, in an interview. “So, our goal was to educate these patients thoroughly on the risks and benefits of each of these therapies and try to understand what guides their choice of third-line therapy based on their lifestyle and what suits them,” added Kapur, urology resident at Stony Brook University, Stony Brook, New York.

The prospective cohort in this study was comprised of 85 patients who were eligible for third-line OAB therapies. Patients who were under the age of 18, did not speak English, or had a developmental disability were excluded from participating.

A 6-minute educational video was created by investigators to inform participants on all 3 third-line therapies that are currently offered to OAB patients in the real-world: intradetrusor onabotulinumtoxinA (Botox), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNS).

After viewing the video, participants were asked to fill out a survey, in which they ranked their preferences for third-line therapies on a scale of 1 to 3. The participants additionally chose specific features of each therapy that they found the most and least appealing.

Results found that 38% (32/85) of patients preferred onabotulinumtoxinA, 37% (31/85) preferred PTNS, and 13% (11/85) preferred SNS, whereas 13% (11/85) did not prefer any of the options.

“I was actually a little surprised that only 13% of patients stated they didn’t find any of these procedures appealing,” said co-author Jason Kim, MD. “We know there’s a significant proportion of the population that is undertreated and given the fact that…many patients don’t go on to third-line therapy, I would have expected that there may have been more patient dissatisfaction with the 3 treatment choices,” added Kim, clinical assistant professor of urology at Stony Brook University.

Furthermore, findings suggested that there were significant associations between onabotulinumtoxinA and age and PTNS and age. More patients in the 65 and older age group preferred onabotulinumtoxinA as their No. 1 therapy (P = .003), and more patients in the 18–64-year age group preferred PTNS as their No. 1 therapy (P = .044). Education level and income did not play a significant role in preference.

Data also revealed that the most attractive feature of onabotulinumtoxinA was its lasting effect (48%), and the least attractive feature was the potential for catheterization due to urinary retention (52%). The most attractive features for PTNS were that it does not require surgery (35%) and there are no reported significant complications (36%), and the least attractive feature was the need for frequent office visits (59%). The most and least attractive features for SNS were the potential long-term relief without frequent office visits (54%), and the need for an implanted device (29%).

In addition to highlighting the value of this study’s results for counseling future patients, Kapur added, “The study shows that we really do need to try to anticipate what the needs are of our patients, and [determine] what those barriers may be to the patients actually going through with the therapy and then being satisfied.”

“I think there’s a disconnect between the patients saying they’re interested in these therapies, and the patients that actually go on to [receive] them,” Kim added, “and I’d like to study where the disconnect comes from.”


1. Kapur A, Cohen T, Dabrowski C, et al. Patient preference of third line therapy for overactive bladder. Paper presented at: 2022 Society of Women in Urology Annual Clinical Mentoring Conference; February 7-9, 2022; New Orleans, Louisiana. Poster #5917.