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The patient pathway for overactive bladder management: A quantitative analysis
Author(s) -
Seinen Auke. J.,
Elburg Rogier,
Hollegien Lianne M.,
Blanker Marco H.,
Witte Lambertus P. W.
Publication year - 2022
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.24817
Subject(s) - medicine , overactive bladder , discontinuation , retrospective cohort study , mirabegron , urology , surgery , alternative medicine , pathology
Purpose We aimed to explore the pathways followed by patients with overactive bladder (OAB) from referral to the urologist to final treatment. Methods This was a single‐center, retrospective cohort study of female patients diagnosed with OAB in a large Dutch nonacademic teaching hospital. The number, sequence, and duration of treatment steps offered were analyzed, and the effectiveness, reasons for discontinuation, and possible case‐mix variables influencing OAB treatment were studied. Results In total, 120 patients were enrolled and required a median of 2 steps (range, 1–6) of treatment over a median total duration of 28 weeks (range, 5–256). Treatment typically started with drug therapy, including antimuscarinics (38%; 95% CI, 30%–47%), antimuscarinics plus pelvic floor muscle therapy (21%; 95% CI, 15%–29%), or mirabegron (11%; 95% CI, 6%–18%). However, 52% of patients required further treatment, with botulinum toxin A (BoNT‐A) injections being most effective (67%; 95% CI, 42%–85%), followed by antimuscarinics plus percutaneous tibial nerve stimulation (50%; 95% CI, 25%–75%), and antimuscarinics plus pelvic floor muscle therapy (36%; 95% CI, 21%–54%). Other therapies showed lower effectiveness. Common reasons for discontinuation were insufficient response and side effects. Overall, 22 patients were lost to follow‐up. Conclusion Most patients try at least two treatments before they experience satisfactory symptom relief, with treatment evaluations requiring time because therapeutic onsets differ by patient and treatment. Our data can help to manage expectations among urologists and patients when seeking treatment for OAB.