(Poster 42) Patient Factors Associated with Use of Advanced Therapy for Overactive Bladder

Objectives: Assess for patient factors associated with uptake of advanced therapy in women presenting with bothersome Overactive Bladder (OAB) symptoms over 1 year

Methods: We performed a retrospective cohort study of patients in an academic urogynecology practice. Patients were included if they were at least 18 years old and presenting for evaluation of overactive bladder symptoms from January 2022 to December 2022. Patients were excluded if they had prior surgical treatment of pelvic organ prolapse (POP) or stress urinary incontinence (SUI), or if follow up questionnaires were not available. We collected baseline characteristics, medical and surgical history, use of advanced therapy for OAB symptoms, baseline Pelvic Floor Distress Inventory 20 (PFDI-20) scores and assessment of symptom improvement. Advanced therapy was defined as intradetrusor onabotulinum toxin and sacral neuromodulation. Differences in patient characteristics and outcomes were described using chi-square and t-tests where appropriate. Multivariable logistic regression analyses were performed to determine factors associated with uptake of advanced therapy for OAB.

Results: The cohort included 398 patients. The average age was 64 years (standard deviation ±14.7) and most patients were white (76%). Most women were postmenopausal (51%) and 36% had prolapse beyond the hymen at the new patient visit. Of the 398 patients, 279 (75%) started any OAB treatment, and 81 of these patients (29%) were started on advanced therapy over the course of 1 year. Table 1 describes the characteristics of patients who received advanced therapy compared to those who did not. Patients who underwent advanced therapy for OAB were more likely to be older and have higher scores on the Urinary distress inventory-6 (UDI-6) question 16 (“do you usually experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom?”), total UDI-6, Pelvic organ prolapse distress inventory-6 (POPDI-6), and Colorectal-Anal distress inventory-8 (CRADI-8) (Table 1). Total PFDI scores did not differ between those who underwent advanced UUI therapy and those who did not (Table 1). On multivariable logistic regression controlling for age, prolapse, smoking and alcohol use, scores for question 16 (“do you usually experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom?”) on the UDI-6 were associated with higher odds of uptake of advanced therapy for OAB (Table 2).

Conclusions: Among patients presenting to a urogynecology clinic with complaints of OAB, increased severity of UUI was associated with an increased likelihood in uptake of advanced therapy for OAB over the course of 1 year.