Outcomes following intradetrusor onabotulinumtoxinA injections and sacral neuromodulation in older men

Objectives: This study aims understand the outcomes following intradetrusor onabotulinumtoxinA injections and sacral neuromodulation (SNM) in a national cohort of male Medicare beneficiaries with overactive bladder (OAB). Subjects and Methods: This is a retrospective cohort study of a 100% sample of fee-for-service male Medicare beneficiaries undergoing first-time onabotulinumtoxinA injections or SNM test procedures from 2014 to 2016. The primary outcome was repeat onabotulinumtoxinA injections within 1 year of index injections and placement of implantable pulse generator (IPG) within 90 days of a SNM test procedure. Results: Overall, 11 286 male beneficiaries were included; 31.4% who underwent onabotulinumtoxinA injections had repeat injections within 1 year and 56.0% who underwent SNM test procedures had an IPG implant within 90 days. Repeat onabotulinumtoxinA injections were less likely among men who were ≥85 years (adjusted relative risk [aRR] 0.85, 0.75-0.96) versus ages 65-74. IPG implantation was more likely following staged versus percutaneous nerve evaluation (PNE; aRR 1.57, 1.50-1.64) and among beneficiaries in the lowest versus highest of socioeconomic quartile (aRR 1.10, 1.03-1.18). Conclusions: Rates of repeat treatments following index onabotulinumtoxinA injections among older men were lower than those previously reported among younger, predominantly female populations, whereas rates of IPG implantation were similar. Interestingly, frailty and comorbidity were not associated with these claims-based treatment outcomes following either procedure, but certain non-clinical variables were associated with IPG implantation following SNM. While these outcomes cannot distinguish symptom improvement from discontinuation because of lack of efficacy, adverse events or patient preference, they provide important insights into real-world treatment patterns for a patient population which is under-sampled in the OAB literature.