A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third‐line therapies?

Abstract

Aims: Third-line therapies are efficacious in improving overactive bladder (OAB) symptoms; however, OAB patients have poor follow-up and rarely progress to these therapies. Clinical care pathways (CCP) may improve OAB follow-up rates and third-line therapy use. We sought to determine how new OAB patients follow up and utilize third-line therapies with the implementation of an OAB CCP in a fellowship Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained urologist's academic practice. Methods: We identified new OAB patients using ICD-9 and 10 codes. They were placed into two groups: pre-and post-CCP use. Basic demographic data were collected. Patients were evaluated in a retrospective longitudinal fashion over 12 months to determine follow-up and third-line therapy utilization. Results: A total of 769 new OAB patients (261 pre-CCP and 508 post-CCP) were identified. The mean number of follow-up visits increased significantly at 6 months (0.94 vs. 1.64 visits, p = .001) and 12 months (1.26 vs. 2.46 visits, p < .003). Follow-up rates increased significantly at 3 months (38.7% vs. 50.2%, p = .002). Mean time to third-line therapy decreased significantly (280 days vs. 160 days, p = .016). Third-line therapy utilization therapy rates increased at 6 months (7.7% vs. 13.4%, p = .018) and at 12 months (11.1% vs. 16.5%, p = .044). Conclusions: New OAB patients follow-up and progress to third-line therapies faster and more frequently with the use of a CCP in an FPMRS-trained urologist practice. However, many OAB patients still fail to follow up and overall utilization of third-line therapies remains low. Future studies are warranted to identify factors to why overall OAB compliance remains low.

Busting for change: a care pathway for overactive bladder

“…Clinical care pathways (see Figure 1) should be used to guide clinicians and patients alike toward third‐line therapy if indicated, with evidence to demonstrate that this will lead to increased utilisation of third‐line management from 7.7% to 13.4% for patients with OAB 20 …”

Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study

“…It is possible that if we followed our cohort beyond 12 months that a greater proportion of patients would be escalated to third‐line treatments. In 2021, Du et al 22 published a retrospective cohort study of new OAB patients presenting to a specialty care clinic to determine the impact of an OAB clinical care pathway on the rate of and time to third‐line treatments. The clinical care pathway increased rates of third‐line treatment from 7.7% to 13.4% at 6 months and 11.1% to 16.5% at 12 months while decreasing the time to third‐line treatments from 280 to 160 days.…”

Six-Month Outcomes of Reimplantation of a Coin-Sized Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome With Urgency Urinary Incontinence

“…Third-line treatment options are underpenetrated as well because patients rarely progress to these therapies or have poor retention rates. 10 The eCoin® (Valencia Technologies Corp., Valencia, CA) is an investigational, fully implanted, neuromodulation device indicated for the treatment of OAB with refractory UUI. It is intended to treat UUI by electrically stimulating the tibial nerve, which is presumed to improve or restore normal control of an imbalanced voiding reflex by retrograde stimulation of the lumbosacral nerves (L4-S3).…”

“…Despite availability of first-line behavioral modifications and second-line medications, many patients are still undertreated. Third-line treatment options are underpenetrated as well because patients rarely progress to these therapies or have poor retention rates 10 …”

“…Third-line treatment options are underpenetrated as well because patients rarely progress to these therapies or have poor retention rates. 10 …”