title: Women's perspective: intra-detrusor botox versus sacral neuromodulation for overactive bladder symptoms after unsuccessful anticholinergic treatment.
abstract: OBJECTIVE
  Comprehension of women's perspective and reasons for their choice between intra-detrusor botox (botox) and sacral neuromodulation (SNM) after failed anticholinergic treatment for overactive bladder syndrome (OAB) have not been evaluated and reported in the literature. Our voluntary service evaluation survey aimed to determine reasons behind individual patient choice.
  
  
  METHODS
  All women were counseled in detail regarding the two treatment options available after failed anticholinergic treatment as per the hospital trust policy. Once the decision-making process was completed, they were asked to highlight one or more of the 12 questions within the survey that influenced their decision-making process.
  
  
  RESULTS
  Fifty patients, with a mean age of 61.66 years (range 38-82 years) participated in our voluntary survey. Seventy-four per cent chose Botox and 26% chose SNM. In the botox group 54.05% disliked the thought of a foreign body in the back with SNM; 45.94% quoted shorter waiting times and 43.24% said that the quicker onset of benefit (within 3-5 days) with botox compared with SNM (up to 2 weeks) helped to influence their decision towards botox. In the SNM group 61.53% were averse to the potential need for botox to be repeated at variable intervals; 46.15% chose SNM to avoid the risk of urinary retention associated with botox.
  
  
  CONCLUSIONS
  The botox group seemed more likely to need quicker results with easy access to the treatment modality, whilst the SNM group seemed keener to focus on a more permanent option with a known interval for the repeat procedure. The difference in patient choice was found to be statistically significant.
authors.affiliation: Department of Urogynaecology, St James's University Hospital, Level 1, Chancellor Wing, Beckett Street, Leeds, LS97TF, UK, poojabalchandra@gmail.com.
authors.forename: Pooja
authors.initials: P
authors.lastname: Balchandra
authors.forename: Lynne
authors.initials: L
authors.lastname: Rogerson
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002755:Choice Behavior; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008160:Lumbosacral Plexus; D008875:Middle Aged; D057240:Patient Preference; D019233:Retreatment; D011795:Surveys and Questionnaires; D013997:Time Factors; D017211:Treatment Failure; D053201:Urinary Bladder, Overactive / Q000628:therapy*
chemical_list: D065087:Acetylcholine Release Inhibitors; D018680:Cholinergic Antagonists; D019274:Botulinum Toxins, Type A