Shifts in Patient Preference of Third-Line Overactive Bladder Therapy After Introduction of the Implantable Tibial Nerve Stimulator

Kapur A1, Aalami Harandi A1, Kim J1

Research Type


Abstract Category

Overactive Bladder

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Abstract 30
Overactive Bladder and Neuromodulation
Scientific Podium Short Oral Session 6
Wednesday 27th September 2023
14:37 - 14:45
Theatre 102
Urgency/Frequency Overactive Bladder Urgency Urinary Incontinence New Devices Neuromodulation
1. Stony Brook Urology

Arshia Aalami Harandi



Hypothesis / aims of study
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.
Study design, materials and methods
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).
Interpretation of results
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.
Concluding message
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.
Figure 1 Participant Preferences of Third-Line Overactive Bladder Therapy Before (Stage A) and After (Stage B) Introduction of a Tibial Nerve Stimulator Implant
Funding Valencia Technologies Corporation Clinical Trial No Subjects Human Ethics not Req'd It was not required by the Stony Brook University IRB Helsinki Yes Informed Consent Yes

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

17/04/2024 16:20:06