Urinary incontinence (UI) is a highly prevalent geriatric condition that disproportionately affects women. Age‑related alterations in detrusor contractility, urethral function, and sensory signaling contribute to increased voiding frequency, nocturia, and greater urgency urinary incontinence (UUI) severity. These lower urinary tract changes frequently coexist with geriatric syndromes and multimorbidity, complicating the clinical management of overactive bladder (OAB) and UUI in older adults. Despite the high burden of disease, the influence of advancing age beyond 65 years on the effectiveness of OAB and UUI treatments remains insufficiently characterized. We hypothesize that older age is an independent predictor of reduced therapeutic response following procedure‑based interventions for OAB and UUI. This review aims to systematically evaluate the evidence describing the association between age and treatment efficacy of intradetrusor onabotulinumtoxinA, sacral neuromodulation, and posterior tibial nerve stimulation in older women with OAB and UUI.

A scoping review was conducted to evaluate the influence of age on treatment outcomes following intravesical Botox injections, sacral neuromodulation, and posterior tibial nerve  procedures in older women with OAB and urgency UI. A comprehensive search strategy targeting studies of procedure based interventions for urinary incontinence was developed, and electronic databases—including PubMed, MEDLINE (Ovid), Embase, and Web of Science—were systematically queried. Search terms encompassed older women, overactive bladder, urgency urinary incontinence, surgery, procedures, and intravesical Botos, sacral neuromodulation, and posterior tibial nerve stimulation. The search was limited to studies published from 2014 onward. Covidence® software was used to manage study screening and data organization. Eligible studies included those reporting objective or subjective efficacy outcomes after the targeted procedures in women aged ≥65 years. Studies were excluded if they focused on conservative management, included populations with neurogenic lower urinary tract dysfunction, stress urinary incontinence, involved concomitant pelvic organ prolapse surgery, lacked an age stratified analysis, or were scoping/systematic reviews.

After extensive librarian-assisted literature review 9,468 papers were found using Embase (6329), Medline (3137), and PubMed (2). Regarding exclusions, 2,171 duplicates were removed and 6,605 were deemed irrelevant in the title/abstract screening phase. Full texts for 691 studies were retrieved successfully and assessed for eligibility. Of those, 601 were excluded based on the exclusion criteria. This left 90 studies for inclusion in the scoping review. Of those studies, 22 were focused on treatment of urgency urinary incontinence/overactive bladder (8 on intravesical Botox treatments, 5 on sacral neuromodulation, 6 on percutaneous tibial nerve stimulation, 2 on selective bladder denervation, and 1 on apical suspension). The studies included in this review provide varied levels of evidence with 5 studies providing level 2 evidence (RCTs and 2° RCT analyses), 10 studies providing level 3 evidence (Cohort studies), and 2 studies providing level 4 evidence (case series). Of studies on intravesical Botox, 50% reported that age had no impact on treatment success and 50% concluded that age was associated with less change in urgency UI or voiding frequency.  Data on sacral neuromodulation reported 1 study concluded that increased age was associated with needed additional therapies after implantation, while 2 studies did not observe increased age being a predictor of treatment success. Of the data on posterior tibial nerve stimulation, the majority (5/6) concluded that age was not significantly associated with treatment success.

Studies reporting on the success of treatments for OAB and urgency incontinence vary in quality and outcome assessment thus systematic review is not possible. The impact of advanced age on the treatment success of Botox and sacral neuromodulation is inconclusive. However, posterior tibial nerve stimulation is likely not impacted by advanced age.

Studies focused on the treatment of urgency UI and OAB in older women are needed to inform clinical algorithms to deliver precision care.