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Trends and Clinical Practice Patterns of Sacral Neuromodulation for Overactive Bladder

Elterman, Dean S., MD, MSc, FRCSC*; Chughtai, Bilal, MD; Vertosick, Emily, MPH; Thomas, Dominique, BS; Eastham, James, MD; Sandhu, Jaspreet, MD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 264–266
doi: 10.1097/SPV.0000000000000449
Original Articles

Objectives The aim of this study was to investigate surgical practice patterns of American urologists treating refractory overactive bladder (OAB) over the past decade. Refractory OAB remains a management challenge to urologists. When multiple medical therapies have failed, treatment options may include sacral neuromodulation (SNM) or surgery such as augmentation cystoplasty (AC).

Methods Data on SNM and AC performed between 2003 and 2012 by certifying and recertifying urologists were obtained in the form of annualized case logs from the American Board of Urology (ABU). Associations between surgeon characteristics (type of certification, annual volume, practice type, and location) and these procedures were evaluated.

Results Over the past decade, 756 of 6355 urologists certified with the ABU performed SNM or AC for the treatment of refractory OAB. Forty-five (6%) of these surgeons completed fellowships in female urology and 71 surgeons (9%) completed another type of fellowship program. Surgeons recertifying with ABU performed 76% of all SNM procedures. Although SNM and AC have increased from 64 to 2086 between 2003 and 2012, however, this is mainly driven by the increase of SNM from 48 to 2068 cases. Rates of AC have remained stable with 14 to 38 cases reported annually. However, they have declined relative to the total, from 25% in 2003 to less than 1% in 2012.

Conclusions Sacral neuromodulation has increased dramatically over the past decade in surgeons certified with the ABU. This is in contrast to AC, which while remaining stable in number of procedures.

In comparison with augmentation cystoplasty, sacral neuromodulation has increased over the past decade among surgeons certified with the American Board of Urology.

From the *Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada;

Department of Urology, Weill Cornell Medical College; and

Urology Section, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

Correspondence: Bilal Chughtai, MD, Departments of Urology, and Obstetrics and Gynecology, Weill Cornell Medical College, 425 East 61st St, 12th Floor, New York, NY 10065. E-mail: bic9008@med.cornell.edu.

The authors have declared they have no conflicts of interest.

Dean S. Elterman, MD, MSc, FRCSC, and Bilal Chughtai, MD, are co–first authors.

Drs Elterman, Chugthai, and Sandhu conceived the study design. All authors contributed to article preparation and editing. Statistical analysis was conducted by Emily Vertosick. Data were acquired under a data-user agreement by the American Board of Urology and supported by the Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan Kettering Cancer Center.

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