Introduction: An estimated 18% of Canadians have overactive bladder (OAB), with approximately 24% of those reporting difficulty adhering to pharmacotherapy.^1,2 Although the proportion of medically refractory OAB is substantial, the availability of choice in patients’ treatment is limited. To date, there has been no investigation into barriers facing sacral neuromodulation (SNM) as a 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 and respondent characteristics are outlined in Table 1. The majority of 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%), lack of expertise (n=49, 34.5%), and funding (n=26, 18.3%). On a five-point Likert scale, 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 (Figure 1), 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 cited 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.