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Peer-reviewedCC BYUrology

Trends in the utilization of minimally invasive therapies for overactive bladder among older adults: a national Medicare study

  • Adam Crow1
  • Lufan Wang2
  • Abigail Shatkin-Margolis3
  • Unwanaobong Nseyo4
  • Stephanie W. Zuo5
  • W. John Boscardin2
  • Ken Covinsky6
  • Anne M. Suskind7
7 affiliations
  1. 1University of California, Davis School of Medicine, 4610 X Street, Sacramento, CA 95817, USA
  2. 2Department of Biostatistics and Epidemiology, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143, USA
  3. 3Department of Obstetrics and Gynecology, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143, USA
  4. 4Department of Urology, Weill Cornell School of Medicine, 525 East 68th Street, New York, NY 10065, USA
  5. 5Department of Obstetrics and Gynecology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908, USA
  6. 6Division of Geriatrics, Department of Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA 94143, USA
  7. 7Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
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Abstract

OBJECTIVE: To examine population-based trends in utilization of minimally invasive therapies (MITs) for overactive bladder (OAB) stratified by age and frailty among Medicare beneficiaries. METHODS: This population-based study used a 20% sample of fee-for-service Medicare beneficiaries to investigate rates of utilization for MIT for OAB [onabotulinumtoxinA injections (BTX), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM)] from 2015 to 2020. Adjusted incidence rates of each MIT were further stratified by age and frailty, measured by the Claims-based Frailty Index (CFI), using multivariable logistic regression. RESULTS: Among 5,944,458 beneficiaries, 39,211 (0.7%) underwent an MIT for OAB during the study period. Overall adjusted incidence increased from 141.2 per 100,000 in 2015-159.3 per 100,000 in 2019 (a 13% relative increase), driven largely by BTX (40% relative increase). Incidence decreased across all MITs in 2020. Among beneficiaries aged 66-84, greater levels of frailty were associated with higher use of all 3 therapies. However, this association was not observed in beneficiaries over age 85, where rates of use were uniformly low regardless of frailty status. CONCLUSION: Use of MITs for OAB increased from 2015 to 2019, mainly driven by increases in BTX. For all 3 types of MITs, greater levels of frailty were associated with increased utilization among beneficiaries <85 years, regardless of age, while rates for all 3 procedures were low regardless of frailty for beneficiaries ≥85, indicating that utilization of these procedures is driven more by age than frailty in the oldest age group. Further research is needed to determine the factors which influence MIT utilization rates.

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Cite

BibTeXRIS
BibTeX
@article{crow2026trends,
  title = {{Trends in the utilization of minimally invasive therapies for overactive bladder among older adults: a national Medicare study}},
  author = {Adam Crow and Lufan Wang and Abigail Shatkin-Margolis and Unwanaobong Nseyo and Stephanie W. Zuo and W. John Boscardin and Ken Covinsky and Anne M. Suskind},
  journal = {Urology},
  year = {2026},
  month = sep,
  doi = {10.1016/j.urology.2026.09.014},
  url = {https://doi.org/10.1016/j.urology.2026.09.014},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Trends in the utilization of minimally invasive therapies for overactive bladder among older adults: a national Medicare study
AU  - Adam Crow
AU  - Lufan Wang
AU  - Abigail Shatkin-Margolis
AU  - Unwanaobong Nseyo
AU  - Stephanie W. Zuo
AU  - W. John Boscardin
AU  - Ken Covinsky
AU  - Anne M. Suskind
PY  - 2026
DA  - 2026/09/18
JO  - Urology
DO  - 10.1016/j.urology.2026.09.014
UR  - https://doi.org/10.1016/j.urology.2026.09.014
AB  - OBJECTIVE: To examine population-based trends in utilization of minimally invasive therapies (MITs) for overactive bladder (OAB) stratified by age and frailty among Medicare beneficiaries. METHODS: This population-based study used a 20% sample of fee-for-service Medicare beneficiaries to investigate rates of utilization for MIT for OAB [onabotulinumtoxinA injections (BTX), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM)] from 2015 to 2020. Adjusted incidence rates of each MIT were further stratified by age and frailty, measured by the Claims-based Frailty Index (CFI), using multivariable logistic regression. RESULTS: Among 5,944,458 beneficiaries, 39,211 (0.7%) underwent an MIT for OAB during the study period. Overall adjusted incidence increased from 141.2 per 100,000 in 2015-159.3 per 100,000 in 2019 (a 13% relative increase), driven largely by BTX (40% relative increase). Incidence decreased across all MITs in 2020. Among beneficiaries aged 66-84, greater levels of frailty were associated with higher use of all 3 therapies. However, this association was not observed in beneficiaries over age 85, where rates of use were uniformly low regardless of frailty status. CONCLUSION: Use of MITs for OAB increased from 2015 to 2019, mainly driven by increases in BTX. For all 3 types of MITs, greater levels of frailty were associated with increased utilization among beneficiaries <85 years, regardless of age, while rates for all 3 procedures were low regardless of frailty for beneficiaries ≥85, indicating that utilization of these procedures is driven more by age than frailty in the oldest age group. Further research is needed to determine the factors which influence MIT utilization rates.
SN  - 0090-4295
SN  - 1527-9995
ER  -