(Poster 180) A Bladder Care Pathway to Improve Third-Line Therapy Penetrance in OAB Patients

Objectives: To assess if a bladder care pathway was effective at improving third-line therapy penetrance rates among overactive bladder (OAB) patients.

Methods: This was a retrospective cross-sectional study of women 18 years of age and older with a diagnosis of OAB or associated symptoms. A bladder care pathway was developed following the American Urologic Association/ Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines for treatment of OAB (Figure 1). Treatments specifically discussed included behavioral changes, medications, and third-line therapies. The goal was to improve understanding of treatment options in patients with OAB who traditionally demonstrate high attrition rates. All patients received a paper copy of the pathway as well as direct education regarding the pathway from the physician. Patients seen between January 1st, 2022 and December 31st, 2022 served as controls as they did not receive the bladder care pathway. Those seen between January 1st, 2024 and December 31st, 2024 were given the pathway and direct physician education. The total number of patients presenting with OAB and the total number of those receiving third-line therapies were collected for both time intervals.

Results: From 2022 to 2024 there was a 10.5% increase in patients seen with a diagnosis of OAB or associated symptoms. When assessing third-line therapies, we included only onabotulinumtoxinA and sacral neuromodulation treatments as posterior tibial nerve stimulation is not frequently utilized in this practice. The number of patients receiving third-line therapy increased by 22% from 2022 to 2024. When looking at the distribution between onabotulinumtoxinA injections and sacral neuromodulation, in 2022, 76% of patients who completed third-line therapy underwent onabotulinumtoxinA injections compared to only 64% in 2024. Notably, 35% of patients of the patients who completed third-line therapy received sacral neuromodulation in 2024, an increase from 25% in 2022.

Conclusions: In a large hybrid academic and private practice, the number of patients receiving third-line therapy increased by 22% after implementation of a bladder care pathway. This easy to implement tool may help increase understanding of treatment options and decrease attrition rates for patients with a diagnosis of overactive bladder.

Figure 1 - Bladder care pathway