{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:44:31Z","timestamp":1791045871614,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Third\u2010line therapies for overactive bladder (OAB) that are currently recommended include intravesical Onabotulinumtoxin\u2010A injections (BTX\u2010A), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). The implantable tibial nerve stimulator (ITNS) is a novel therapy that is now available to patients with OAB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to analyze shifts in patient preference of third\u2010line therapies for OAB after introducing ITNS as an option among\u00a0the previously established therapies for non\u2010neurogenic OAB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A survey was designed and distributed via SurveyMonkey to the platform's audience of U.S. adults of age 18 and older. Screening questions were asked to include only subjects\u00a0who reported symptoms of OAB. Descriptions of current AUA\/SUFU guideline\u2010approved third\u2010line therapies (BTX\u2010A, PTNS, and SNM) were provided, and participants were asked to rank these therapies in order of preference (stage A). Subsequently, ITNS was introduced with a description, and participants were then asked to rank their preferences amongst current guideline\u2010approved therapies and ITNS (stage B). Absolute and relative changes in therapy preferences between stage A and stage B were calculated. Associations between ultimate therapy choice in stage B and participant characteristics were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 485 participants completed the survey (62.5% female). The mean age was 49.1\u2009\u00b1\u200936.5 years (SD). The most common OAB symptoms reported were urgency urinary incontinence (UUI) (73.0%) and urinary urgency (68.0%). 29.2% of patients had tried medication for OAB in the past, and 8.0%\u201310.3% of patients were previously treated with a third\u2010line therapy for OAB. In stage A, participants ranked their first choice of third\u2010line therapy as follows: 28% BTX\u2010A, 27% PTNS, and 13.8% SNM. 26.6% of participants chose no therapy, and 4.5% chose all three equally. In stage B, participants ranked their first choice as follows: 27.6% BTX\u2010A, 19.2% PTNS, 7.8% SNM, and 19.2% ITNS. 21.9% of participants chose no therapy and 4.3% chose all four equally as their first choice. There were both absolute and relative declines in proportions of patients interested in BTX\u2010A, SNM, and PTNS as their first choice of third\u2010line therapy with the introduction of ITNS. Patients originally interested in PTNS in stage A had the greatest absolute change after the introduction of ITNS with 7.8% of participants opting for ITNS in stage B. Those interested in SNM in stage A had the largest relative change in interest, with 43.5% of those originally interested in SNM opting for ITNS in stage B. Finally, with the introduction of ITNS, the number of participants initially not interested in any third\u2010line therapy declined by an absolute change of 4.7% and relative change of 17.6%. Participants experiencing concurrent stress urinary incontinence (SUI) symptoms\u00a0were more likely to choose a current guideline\u2010approved third\u2010line therapy than ITNS or no therapy at all (<jats:italic>p<\/jats:italic>\u2009=\u20090.047). Those who had prior experience with third\u2010line therapies were more likely to choose a third\u2010line therapy other than ITNS as their ultimate choice of therapy in stage B. Of those who had chosen a guideline\u2010approved\u00a0third\u2010line therapy in stage B (not ITNS), 13.6% had prior experience with BTX\u2010A, 14.7% with PTNS, and 32 (11.2%) with SNM (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>p<\/jats:italic>\u2009=\u20090.009, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>From our study, it appears that ITNS may attract a subset of patients who would not have otherwise pursued current guideline\u2010approved third\u2010line therapies for OAB. When patients are provided with descriptions of third\u2010line OAB therapies including ITNS as an option, ITNS appears to compete with SNM and PTNS. It is possible that ITNS will provide patients with a different phenotype of neuromodulation therapy that can appeal to a niche OAB population. Given that ITNS devices have been introduced relatively\u00a0recently to the market, their application will largely depend on cost and payer coverage, provider bias, and patient comorbidities. Further study is needed to understand how these factors interact with and influence patient preference of advanced OAB therapy to understand which patients will most benefit from this treatment modality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/nau.25421","type":"journal-article","created":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T10:39:06Z","timestamp":1708684746000},"page":"959-966","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Shifts in patient preference of third\u2010line overactive bladder therapy after introduction of the implantable tibial nerve stimulator"],"prefix":"10.1002","volume":"43","author":[{"given":"Anjali","family":"Kapur","sequence":"first","affiliation":[{"name":"Department of Urology Stony Brook Medicine Stony Brook New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arshia","family":"Aalami Harandi","sequence":"additional","affiliation":[{"name":"Department of Urology Stony Brook Medicine Stony Brook New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Hartman\u2010Kenzler","sequence":"additional","affiliation":[{"name":"Department of Urology Stony Brook Medicine Stony Brook New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology Stony Brook Medicine Stony Brook New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24864"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000000309"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24936"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.25046"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2021.02.005"},{"key":"e_1_2_11_7_1","first-page":"351","article-title":"New implantable tibial nerve stimulation devices: review of published clinical results in comparison to established neuromodulation devices","volume":"11","author":"Yamashiro J","year":"2019","journal-title":"Res Rep Urol"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2012.09.079"},{"issue":"4","key":"e_1_2_11_9_1","article-title":"MP19\u201014\u2003who receives third line therapies for overactive bladder? trends from data in the AUA AQUA registry","volume":"209","author":"Shapiro K","year":"2023","journal-title":"J Urol"},{"issue":"5","key":"e_1_2_11_10_1","first-page":"S46","article-title":"How can we better manage drug\u2010resistant OAB\/DO? ICI\u2010RS 2018","volume":"38","author":"Chermansky C","year":"2019","journal-title":"Neurourol Urodyn"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1352458519894714"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000001733"},{"issue":"4","key":"e_1_2_11_13_1","article-title":"LBA01\u201005\u2003pivotal study of a novel wirelessly powered, patient tailored programmed, tibial neurostimulator for the treatment of patients with overactive bladder","volume":"209","author":"Heesakkers J","year":"2023","journal-title":"J Urol"}],"container-title":["Neurourology and Urodynamics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.25421","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T06:41:43Z","timestamp":1713940903000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/nau.25421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,23]]},"references-count":12,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1002\/nau.25421"],"URL":"https:\/\/doi.org\/10.1002\/nau.25421","archive":["Portico"],"relation":{},"ISSN":["0733-2467","1520-6777"],"issn-type":[{"value":"0733-2467","type":"print"},{"value":"1520-6777","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,23]]},"assertion":[{"value":"2023-10-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}