Analyzing Trends in Management of Intravesical Therapy-Associated Lower Urinary Tract Symptoms for Patients Treated for Non-muscle Invasive Bladder Cancer.

Authors

Jacob E Tallman, Max J Hyman, Piyush K Agarwal, Sarah F Faris, Parth K Modi

Published in

Urology. Oct 09, 2026. Epub Oct 09, 2026.

Abstract

To characterize the utilization of oral pharmacotherapy and minimally invasive non-pharmacologic treatments approved for overactive bladder among patients receiving intravesical therapy for non-muscle invasive bladder cancer, as this treatment is frequently complicated by lower urinary tract symptoms, which are associated with treatment discontinuation and worse oncological outcomes.
We conducted a retrospective cohort study using the Merative™ MarketScan® Commercial Database (2016-2024). We identified patients with bladder cancer receiving intravesical bacillus Calmette-Guérin or chemotherapy. The primary outcome was the receipt of lower urinary tract symptom therapy-oral pharmacotherapy (anticholinergics, β-3 agonists, alpha blockers) or minimally invasive non-pharmacologic treatments (botulinum toxin injection, sacral neuromodulation, percutaneous tibial nerve stimulation)-in the 180 days after initiating induction therapy.
Among 2,978 patients, 29.6% received lower urinary tract symptom therapy. Use of alpha blockers (19.9%) and anticholinergics (13.7%) predominated. Use of β-3 agonists (1.3%) or non-pharmacologic treatments was exceedingly rare: only 0.3% received botulinum toxin injection, and no patients received sacral neuromodulation or percutaneous tibial nerve stimulation. Lower urinary tract symptom therapy was associated with a lower proportion of patients completing induction therapy (75.9% vs. 79.0%) (P=0.049) and higher proportion of patients undergoing cystectomy (14.8% vs. 11.9%) (P=0.021).
While nearly one-third of bladder cancer patients require pharmacotherapy for lower urinary tract symptoms during intravesical treatment, β-3 agonists and non-pharmacologic treatments are almost entirely unutilized. Given the association between lower urinary tract symptoms and induction therapy non-completion, further research into these advanced therapies is warranted to improve patient adherence and oncologic outcomes.

PMID:
42854855
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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