Women who report symptoms of overactive bladder (OAB) are often managed with multiple treatments. Currently, limited data exist describing treatment patterns for OAB over time. The aim of this study was to describe the treatment patterns over 1-year for women presenting to specialty care with urinary urgency (UU) and/or urinary urgency incontinence (UUI).

This is an analysis of data from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN), a multi-center 1-year prospective cohort study that comprised of participants seeking care for lower urinary tract symptoms (LUTS). This analysis included adult women who reported bothersome UU and/or UUI of “sometimes” or “greater” on the LUTS Tool. UU was defined as a sudden need to rush to urinate or a sudden need to rush to urinate for the fear of leaking; UUI was defined leaked urine in connection with a sudden need to rush to urinate. Participants were queried at baseline and at each of four follow up visits regarding any previous and current UU or UUI treatments over the 12 months of follow up. Treatment groups were ordered from least to more invasive: 1) no treatment, 2) behavioral therapy (BT), 3) physical therapy (PT), 4) OAB medications, 5) percutaneous tibial nerve stimulation (PTNS), 6) intradetrusor onabotulinumtoxinA (BTX), and 7) sacral neuromodulation (SNM). Escalation was defined as an increase in treatment level, while de-escalation was defined as a decrease. Treatment escalation and de-escalation and types of treatments were explored graphically.

Among 359 women, 286 reported UUI and 73 reported UU alone at baseline. From baseline to 12 months, 6% of participants reported none of the treatments listed above, 41% reported one type of treatment (36% BT, 3% medication, 2% other), 42% reported 2 types of treatment (24% BT + PT, 16% BT + medication, 2% other), and 11% reported 3+ types of treatments (6% BT + PT + medication, 6% other). Third line treatments were the least used mode of treatment with 13 (4%) participants reporting BTX, 4 (1%) PTNS and 11 (3%) SNM. The figure represents the patterns of treatment escalation and de-escalation during the study period. The most prevalent treatment escalation from baseline to 3 months was a change from BT to medication while the most prevalent de-escalation was BT to no treatment. From baseline to 12 months, 14% of participants reported no change in level of treatment, 63% reported any escalation and 68% reported any de-escalation (not mutually exclusive).

Nearly half of the participants presenting to specialty care with UU and/or UUI reported conservative measures only (BT or no treatment) during the 12-month study period despite reporting bother from these symptoms. Participants who either were on OAB medications at baseline or were started after their first visit tended to stay at this level of treatment over time, and very few participants were escalated to third line treatments.

This study explored the treatment patterns for women with bothersome OAB over a 1-year time period. Patient factors associated with these treatment patterns could be utilized to develop models to predict OAB treatment escalation or de-escalation.