Urologist-perceived barriers and perspectives on the underuse of sacral neuromodulation for overactive bladder in Canada

Authors

  • Peter Gariscsak School of Medicine, Queen's University
  • Gary Gray Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta
  • Stephen Steele Department of Urology, Queen's University, Kingston, Ontario
  • Dean S. Elterman Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario
  • R. Christopher Doiron Department of Urology, Queen's University, Kingston, Ontario

DOI:

https://doi.org/10.5489/cuaj.8176

Keywords:

sacral neuromodulation, overactive bladder, traditional domains framework, healthcare utilization

Abstract

INTRODUCTION: An estimated 18% of Canadians have overactive bladder (OAB), with approximately 24% of those reporting difficulty adhering to pharmacotherapy. To date, there has been no investigation into barriers facing sacral neuromodulation (SNM) as treatment for OAB in Canada.

METHODS: Current Canadian Urological Association members were invited to participate in an anonymous survey. Data collected included open-ended and Likert scale responses addressing barriers to referral for SNM. Qualitative analysis used a Theoretical Domains Framework (TDF), while quantitative responses are reported using descriptive statistics.

RESULTS: A response rate of 20.4% (n=142) was obtained. Most respondents believed SNM was underused (n=82, 57.7%) compared to only 6.3% (n=9) who believed it was used adequately. The most commonly cited reasons for not offering SNM were lack of availability (n=85, 59.9%), expertise (n=49, 34.5%), and funding (n=26, 18.3%). Participants were neutral regarding confidence to appropriately recommend SNM to patients (median 3, interquartile range [IQR] 2–4) and were not confident to manage patient care and issues related to SNM devices (median 2, IQR 1–3). On thematic analysis using the TDF, the most prevalent barriers to SNM care were related to infrastructure and resources. A lack of trained experts and lack of knowledge related to SNM use were also commonly identified barriers.

CONCLUSIONS: In this first study exploring urologist-perceived barriers to SNM referral for medically refractory OAB in Canada, urologists acknowledge that SNM implantation is underused but did not feel confident in recommending SNM appropriately. A lack of trained experts and poor funding were also identified as major barriers to SNM referral.

Downloads

Download data is not yet available.

Downloads

Published

2023-03-20

How to Cite

Gariscsak, P., Gray, G., Steele, S., Elterman, D. S., & Doiron, R. C. (2023). Urologist-perceived barriers and perspectives on the underuse of sacral neuromodulation for overactive bladder in Canada. Canadian Urological Association Journal, 17(6), E165–71. https://doi.org/10.5489/cuaj.8176

Issue

Vol. 17 No. 6 (2023): CUAJ June

Section

Original Research

License

You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:

  • Post the Article on any Web site
  • Translate or authorize a translation of the Article
  • Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
  • Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.

The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.

You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.

The CUA also requires you to warrant the following:

  • That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
  • That all individuals who have made a substantive contribution to the article are acknowledged;
  • That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
  • That the Article does not libel or violate the privacy rights of any third party.