Overactive bladder syndrome (OAB) is a prevalent condition characterized by urinary urgency, frequency, and nocturia, significantly affecting quality of life. Despite advancements in treatment options, physician practices and preferences for managing OAB vary widely, especially between different specialties. This study aims to evaluate the current global trends, preferences, and barriers regarding the selection and use of available third-line therapies for OAB, with a focus on which treatments are most commonly available and preferred in clinical practice.

This cross-sectional survey aimed to gather insights into physicians' practices and opinions regarding OAB management. A 17-item questionnaire was developed and distributed electronically to members of the International Continence Society (ICS). The survey, conducted from April to July 2024, collected anonymous responses from 201 physicians. Data analysis included descriptive statistics, chi-square tests, and ANOVA using R software.

A total of 201 physicians responded, 60.7% of whom had completed fellowship training in relevant specialties. Among third line therapies, Botulinum toxin injections and SNM were the most favored treatments, with 46.2% and 29.9% of respondents rating them highly favorable, respectively. Botulinum toxin was the most common choice for initial third line therapy preference in patients who have failed medication with 60.1% of respondents selecting this therapy (Figure 1). Urogynecologists from OB-GYN specialties were less likely to favor PTNS compared to their urology-trained counterparts (p<0.001). Fellowship training significantly impacted the timing of follow-ups, with fellowship-trained physicians more likely to see patients at 4 weeks post-treatment. Key barriers to advanced therapies included patient resistance to implantable devices (65.8%) and limited neuromodulation training (27.9%).

The management of OAB varies significantly across specialties, with notable differences in treatment preferences and barriers. While botulinum toxin and SNM remain popular choices, the availability of newer therapies such as implantable tibial nerve stimulation remains limited. Understanding these trends can inform future research and clinical guidelines aimed at improving OAB management and addressing barriers to advanced therapies.

In conclusion, this survey highlights the complexities and variations in the advanced management of OAB among physicians.  Many physicians prioritize botulinum toxin over SNM, and they believe patients resist SNM due to concerns about implants. Additionally it appears that third-line treatment preference and decision making were found to be dependent on training and specialty.