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Gender Based Effect Modification of Nerve Stimulator Success in Patients with Overactive Bladder
Bennett Sluis, MA1, Kristian Stensland, MD2, Jay Vance, MS1, Lara MacLachlan, MD2, Arthur Mourtzinos, MD MBA2.
1Tufts University School of Medicine/Lahey Hospital and Medical Center, Boston, MA, USA, 2Lahey Hospital and Medical Center, Burlington, MA, USA.

Background: Patients suffering from overactive bladder (OAB) may be offered sacral nerve stimulation (SNS). Successful SNS implantation may rely on factors at baseline that differ according to gender. The purpose of the present study is to identify factors within male or female gender which are associated with successful SNS implantation and to identify possible effect modification associated with gender.
Methods: Patients undergoing treatment for OAB at Lahey Hospital and Medical Center between 2004 and 2016 were identified. Demographic, clinical and treatment data were extracted from patient charts. Patients were stratified by gender into groups. Within groups, univariate analyses were conducted to identify factors associated with SNS treatment success using chi-squared and t-test statistics as appropriate. A multivariate logistic regression model to predict SNS treatment success was also created within each group. Significance was defined at the α= 0.05 level. The factors significantly associated with SNS treatment success were compared between groups to assess for effect modification.
Results: Of 268 patients in the OAB database, 128 patients met inclusion criteria. Within the male subgroup, 26 of 47 men (44.7%) had successful treatment, compared to 73 of 81 women (90.1%). Within the male group, the factors significantly associated with SNS failure were mean volume at first urge on UDS (80.5ml in SNS failure compared to 126.5ml in SNS success) and smoking (SNS failure more likely to be current smokers, p = 0.039). Similarly, on multivariate analysis only lower volume at first urge was statistically significantly associated with SNS failure (OR=.97, 95%CI 0.94-0.99). Within the female group, there were no statistically significant associations between measured variables and SNS success. Notably, mean volume at first urge on UDS was not statistically significantly associated with SNS failure, though there was a similarly large difference between groups (97.5ml in SNS failure compared to 136.0ml in SNS success). On multivariate analysis in the female group, there were no significant factors associated with SNS success.
Conclusions: SNS is frequently successful at relieving OAB symptoms. The rate of success in men is significantly lower than in women, suggesting that SNS implantation is more effective in woman than men. The best predictor of success for male patients in this study was higher volume at first urge on UDS. Further study is needed to evaluate other predictors of SNS success and to further characterize differentiating characteristics between male and female patients with respect to overactive bladder treatment.


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