Procedure-Based Management of Urgency Urinary Incontinence in the Older Woman

Purpose of Review: Urgency urinary incontinence (UUI) has a significant impact on the physical function and quality of life of women. When conservative treatments fail, procedure-based management can be used to treat refractory symptoms. We review recent updates on the efficacy and complications of these interventions with focus on older adults. Recent Findings: In high quality studies, intradetrusor botulinum toxin injections and sacral neuromodulation (SNM) result in improvement in frequency of UUI episodes. Adverse effects are slightly elevated in older women, but benefits generally outweigh risks. More evidence is needed to help inform the choice between botulinum toxin injections and SNM with regard to safety and efficacy. Percutaneous tibial nerve stimulation (PTNS) shows efficacy and low adverse events, though high quality studies are few. More evidence is needed to support its use as a first-line intervention for refractory UUI, especially in older women. Surgical intervention is associated with significant complications and is only an option in those who have failed all other interventions. Summary: Procedure-based interventions are effective in addressing UUI. Botulinum toxin injections and SNM should be considered after conservative management has failed. PTNS, with its low morbidity, could be considered before botulinum toxin and SNM if future studies support its efficacy, especially in older women. Future directions should aim to examine patient-reported long-term outcomes, especially in older adults, and decrease morbidity, which may increase the safety profile in older adults.