{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T09:36:04Z","timestamp":1793266564100,"version":"4.5.0"},"posted":{"date-parts":[[2026,7,31]]},"group-title":"Urology","reference-count":24,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"name":"NIH NIDDK UroEPI K-12"},{"award":["1K12HD085816"],"award-info":[{"award-number":["1K12HD085816"]}],"id":[{"id":"https:\/\/ror.org\/03r0ha626","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,10,26]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the rate, timing, and predictors of additional therapy among women with idiopathic overactive bladder (OAB) following initial minimally invasive therapies (MIT).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Study Design<\/jats:title>\n                  <jats:p>Retrospective single center cohort study of women with idiopathic OAB treated between 2012 and 2021. Using ICD and procedural codes, we identified women who underwent posterior tibial nerve stimulation (PTNS), sacral neuromodulation (SNM), or intradetrusor onabotulinumtoxinA (BTX). The primary outcome was receipt of additional OAB treatments including OAB medication and\/or a different MIT after initial clinical response to MIT. Kaplan-Meier analysis estimated time to additional therapies; Cox proportional hazards and random survival forest models identified predictors.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>1,007 women were included (PTNS: 459; SNM: 192; BTX: 356). At three years, 68% of PTNS patients, 52% of BTX patients, and 40% of SNM women required additional therapies with most patients receiving a prescription for additional pharmacotherapy rather than receiving a different MIT. Median time to additional treatments was 12 months (PTNS), 30 months (BTX), and 53 months (SNM). Multiple indications for SNM were associated with decreased hazard for AT (HR 0.56 95% CI 0.33-0.95, p=0.03) while recurrent urinary tract infections were associated with needing additional therapies in the BTX cohort (HR 1.8, 95% CI: 1.1-3.2).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Following initial MIT for idiopathic OAB, many women required additional treatment within three years, with most receiving a prescription for pharmacotherapy rather than receiving another MIT.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Why This Matters<\/jats:title>\n                  <jats:p>Overactive bladder (OAB) affects over 33% of women in the United States, and current AUA\/SUFU guidelines have shifted from traditional stepwise therapy toward shared decision-making and multimodal treatment. While minimally invasive therapies (MIT) are effective options for OAB, real-world data on patient trajectories after MIT initiation, including rates of treatment augmentation, crossover, or return to pharmacotherapy, remain limited.<\/jats:p>\n                  <jats:p>This retrospective cohort of 1,007 women with idiopathic OAB provides novel data on post-MIT OAB therapy, with 40\u201368% of patients requiring additional therapy within three years. We noted significant differences in baseline characteristics and treatment tractories between the groups of patients stratified by first MIT and could not directly compare rates of AT between MITs. Factors associated with additional therapy included recurrent urinary tract infections after BTX, whereas multiple indications for SNM were associated with decreased use of AT. Most women who required additional treatment received pharmacotherapy rather than crossing over to a different MIT.<\/jats:p>\n                  <jats:p>These findings reinforce that OAB management is a dynamic, ongoing process rather than a one-time intervention, and that additional therapy is common. Clinicians can use these data to set realistic expectations during counseling, framing additional therapy as a common and anticipated part of the treatment trajectory rather than a treatment failure.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.29.26359239","type":"posted-content","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T16:20:12Z","timestamp":1785514812000},"source":"Crossref","is-referenced-by-count":0,"title":["Additional therapies after minimally invasive treatments in women with OAB"],"prefix":"10.64898","author":[{"given":"Yu","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Urology, Brigham and Women\u2019s Hospital, Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1385-4270","authenticated-orcid":false,"given":"Mahir","family":"Maruf","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1764-8001","authenticated-orcid":false,"given":"Franco A","family":"Simonato","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, MI"},{"name":"Division of Urology, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4603-2879","authenticated-orcid":false,"given":"Whitney K","family":"Hendrickson","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1030-3067","authenticated-orcid":false,"given":"David","family":"Sheyn","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery, Urology Institute, University Hospitals, Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0560-4503","authenticated-orcid":false,"given":"James","family":"Hokanson","sequence":"additional","affiliation":[{"name":"Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6210-4434","authenticated-orcid":false,"given":"Caitlin","family":"Seibel","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0759-3385","authenticated-orcid":false,"given":"J Quentin","family":"Clemens","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3420-8021","authenticated-orcid":false,"given":"Aruna","family":"Sarma","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6977-5280","authenticated-orcid":false,"given":"Giulia M","family":"Ippolito","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Michigan, Ann Arbor, 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