Do Patients Discontinue Overactive Bladder Medications After Sacral Neuromodulation?
Overactive bladder medications (OABM) are often discontinued due to poor tolerability, and recent data shows long-term usage of anticholinergic (AC) OABM is associated with detrimental dose-dependent cognitive effects. Use of 3rd line therapy, including sacral neuromodulation (SNM), can minimize or avoid these potential side effects. However, a subset of patients continue OABM while on 3rd line therapy. We reviewed records of OAB patients to assess the usage of concurrent OABM in patients who have undergone SNM.
We performed a retrospective review of electronic medical records for all patients who underwent SNM from 8/2014-6/2016. Patients were excluded if indication was urinary retention or if they underwent SNM removal. We reviewed clinical characteristics, urodynamic parameters, and filled OABM by an external prescription database. Concurrent therapy was defined as filling an OABM prescription for ≥11 consecutive months at 1 year following SNM surgery. We examined Patient Global Impression of Improvement (PGI-I) and percent improvement. T-test and Fisher&[prime]s exact test were used to compare groups.
78 patients who underwent SNM were identified. 4 patients restarted OABM intermittently >1 year after surgery and were not included in the analysis. Table 1 shows demographic and clinical characteristics. 82.1% (n=64) of patients stopped and never restarted OABM (SNM alone). 12.8% (n=10) of patients consecutively filled OABM prescriptions at least 1 year following surgery (concurrent). Of these patients, 7 filled an AC, 1 filled a beta-3 agonist, and 2 patients filled both medication types sequentially. Concurrent patients were significantly older than SNM alone patients (74.5 vs. 64.9 years, p=0.004). There was no difference between groups regarding BMI, gender, SNM revision, urodynamic parameters, PGI-I, or patient-perceived percent improvement.
>80% of patients who progressed to SNM discontinued OABM and utilized SNM as their sole treatment modality. A smaller portion of patients (12.8%) concurrently used OABM following SNM for ≥1 year. Because symptom improvement and patient satisfaction were equivalent between groups, SNM presents an opportunity to provide patients with a successful outcome while avoiding the cumulative cognitive decline associated with AC medications.