Third line therapies for overactive bladder (OAB) include intravesical OnabotulinumA injections (BTX-A), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The implantable tibial nerve stimulator (ITNS) is a novel treatment modality now available to patients who have failed 1st and 2nd line therapies for OAB. This study sought to analyze shifts in patient preference of 3rd line therapies for OAB after introducing ITNS as a treatment option.

A survey was designed using SurveyMonkey and distributed to the platform’s audience of U.S. adults ages 18-99 of all genders. Screening questions were asked to include patients who expressed symptoms of OAB. Pictorial and text descriptions of BTX-A, PTNS, and SNM were provided. Participants were asked to rank these 3 therapies in order of preference (stage A). Next, ITNS was described, and participants were then asked to rank in order their preference of therapy amongst BTX-A, PTNS, SNM, and ITNS (stage B). SPSS was used to analyze changes in first choice therapy preference between stages A and B.

There was a total of 485 (N) survey respondents, with 62.5% female (303). The mean age of the sample was 49.1 +/- 36.5 years. The breakdown by race was 69% Caucasian, 8% African American, 8% Asian, 13% Hispanic, and 2% Other. 

In stage A, BTX-A was ranked first by the largest proportion of patients (28%), followed by PTNS (27%) and SNM (13.8%). There were 26.6% of participants who did not choose any therapy; 4.5% chose all three 3rd line therapies equally. 

In stage B, BTX-A was again ranked first by the largest proportion of patients (27.6%), followed by ITNS (19.2%), PTNS (19.2%), and SNM (7.8%). There were 21.9% of participants who did not choose any therapy; 4.3% chose all four therapies equally (Table 1).

Preference for BTX-A was minimally changed despite the introduction of ITNS. There was a larger absolute and relative decrease in proportion of patients interested in both PTNS and SNM after ITNS was introduced. ITNS was equally as preferred as PTNS in stage B. The number of patients not interested in any 3rd line therapy decreased between stages A and B, indicating ITNS may have recruited a new subset of patients who previously did not consider any 3rd line therapy for OAB.

ITNS appears to compete with PTNS and SNM, and it may attract patients who would not have otherwise pursued available 3rd line therapies for OAB prior to its introduction. Further study is needed to characterize patients who will optimally benefit from this treatment.

Continence 7S1 (2023) 100748
DOI: 10.1016/j.cont.2023.100748