Global insights into overactive bladder management: A survey of physician preferences and practices

Introduction: 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. Methods: 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. Results: 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 sacral neuromodulation (SNM) were the most favored treatments, with 46.2% and 29.9% of respondents rating them highly favorable, respectively. Urogynecologists from obstetrics and gynecology (OB-GYN) specialties were less likely to favor posterior tibial nerve stimulation (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%). Conclusions: 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.