Do Patients Discontinue Overactive Bladder Medications after Sacral Neuromodulation?

No AccessJournal of UrologyAdult Urology1 May 2019Do Patients Discontinue Overactive Bladder Medications after Sacral Neuromodulation? Katherine Amin, Dena Moskowitz, Kathleen C. Kobashi, Una J. Lee, and Alvaro Lucioni Katherine AminKatherine Amin *Correspondence: Female Pelvic Medicine and Reconstructive Surgery, Section of Urology, Virginia Mason Medical Center, 11000 9th Ave., C7-URO, Seattle, Washington 98101 (e-mail: E-mail Address: [email protected]). More articles by this author , Dena MoskowitzDena Moskowitz More articles by this author , Kathleen C. KobashiKathleen C. Kobashi Financial interest and/or other relationship with Medtronic, Allergan and Avadel. More articles by this author , Una J. LeeUna J. Lee Financial interest and/or other relationship with Medtronic. More articles by this author , and Alvaro LucioniAlvaro Lucioni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000035AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Overactive bladder medications often have poor tolerability or lack of efficacy with many patients progressing to third line therapy such as sacral neuromodulation. Those treated with sacral neuromodulation may avoid the potential side effects of overactive bladder medications while achieving symptom improvement. We evaluated the postoperative rate of discontinuing overactive bladder medications in patients who underwent sacral neuromodulation of refractory overactive bladder. Materials and Methods: We queried a prospectively collected, institutional review board approved database for patients who underwent sacral neuromodulation. Patients were excluded from analysis if the surgical indication was urinary retention or a sacral neuromodulation device was removed 1 year or less postoperatively. We assessed clinical characteristics, urodynamic parameters and filled overactive bladder medications using an external prescription database. Patient perceived postoperative outcomes were examined. Groups were compared by the Student t-test and the chi-square test. Results: Of the 78 patients who met inclusion criteria 82.1% stopped and never restarted overactive bladder medications (the sacral neuromodulation only group). Of the patients 14.1% consecutively continued filling overactive bladder medications 1 year or more following surgery (the concurrent group). There was no difference between the groups in body mass index, gender, sacral neuromodulation revision, urodynamic parameters, the PGI-I (Patient Global Impression of Improvement) or patient perceived percent improvement. However, concurrent patients were significantly older than those who received sacral neuromodulation only (p = 0.002). Conclusions: More than 80% of patients who progressed to sacral neuromodulation discontinued overactive bladder medications and received sacral neuromodulation as the sole treatment. A small portion of patients concurrently used overactive bladder medications following sacral neuromodulation for 1 year or more. However, outcomes were similar in the 2 groups. Sacral neuromodulation is a strategy to provide a successful outcome in refractory cases and yet avoid the potentially detrimental side effects related to overactive bladder medications. References 1. : Defining and managing overactive bladder: disagreement among the experts. Urology 2013; 81: 257. 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Link, Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Female Pelvic Medicine and Reconstructive Surgery, Section of Urology, Virginia Mason Medical Center, Seattle, Washington © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 201, NO. 5, (829-830), Online publication date: 1-May-2019. Volume 201Issue 5May 2019Page: 973-978 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordscholinergic antagonistsurinary bladderelectrodesadverse effectsoveractiveimplantedprostheses and implantsAcknowledgmentDr. Sharon Durfy assisted with manuscript preparation.MetricsAuthor Information Katherine Amin *Correspondence: Female Pelvic Medicine and Reconstructive Surgery, Section of Urology, Virginia Mason Medical Center, 11000 9th Ave., C7-URO, Seattle, Washington 98101 (e-mail: E-mail Address: [email protected]). More articles by this author Dena Moskowitz More articles by this author Kathleen C. Kobashi Financial interest and/or other relationship with Medtronic, Allergan and Avadel. More articles by this author Una J. Lee Financial interest and/or other relationship with Medtronic. More articles by this author Alvaro Lucioni More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. 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