Aims: Third-line therapies are efficacious in improving overactive bladder (OAB) symptoms; however, OAB patients have poor follow-up and rarely progress to these therapies. Clinical care pathways (CCP) may improve OAB follow-up rates and third-line therapy use. We sought to determine how new OAB patients follow up and utilize third-line therapies with the implementation of an OAB CCP in a fellowship Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained urologist's academic practice. Methods: We identified new OAB patients using ICD-9 and 10 codes. They were placed into two groups: pre-and post-CCP use. Basic demographic data were collected. Patients were evaluated in a retrospective longitudinal fashion over 12 months to determine follow-up and third-line therapy utilization. Results: A total of 769 new OAB patients (261 pre-CCP and 508 post-CCP) were identified. The mean number of follow-up visits increased significantly at 6 months (0.94 vs. 1.64 visits, p = .001) and 12 months (1.26 vs. 2.46 visits, p < .003). Follow-up rates increased significantly at 3 months (38.7% vs. 50.2%, p = .002). Mean time to third-line therapy decreased significantly (280 days vs. 160 days, p = .016). Third-line therapy utilization therapy rates increased at 6 months (7.7% vs. 13.4%, p = .018) and at 12 months (11.1% vs. 16.5%, p = .044). Conclusions: New OAB patients follow-up and progress to third-line therapies faster and more frequently with the use of a CCP in an FPMRS-trained urologist practice. However, many OAB patients still fail to follow up and overall utilization of third-line therapies remains low. Future studies are warranted to identify factors to why overall OAB compliance remains low.

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goals and progression towards them. Overall program ranking was 6/7 on likert scale, "very satisfied". Students identified program selection and ERAS application assistance as their main goals, with mentors described as "inspirational", "accessible", and "supportive".CONCLUSIONS: #UroStream101 was a successful pilot program providing mentorship for students. This was desperately needed during an atypical application cycle and provided knowledge that will be invaluable in further developing the program going forward.

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systems options include implantable sacral nerve modulation (SNM) and percutaneous tibial nerve stimulation (PTNS), and only scarce data exist on implantable tibial nerve stimulation systems and none with long-term results. We hereby present 3-year follow-up results on the treatment of patients suffering from refractory OAB with the RENOVA iStimä System; an implantable tibial neurostimulation device.METHODS: A wireless peripheral neurostimulator device (BlueWind Medical Ltd.) was implanted in patients with refractory OAB, on the posterior tibial nerve, approximately 5cm above the medial malleolus. The implant electrically stimulates the tibial nerve and is wirelessly powered by a wearable external control unit (ECU) which controls the therapeutic parameters and is worn by the patient on the lower leg during specified treatment periods in home settings. A Clinician Programmer (CP) unit is used to set individual stimulation parameters for each patient to optimize therapeutic outcome.Twenty OAB patients, who were previously implanted with the RENOVA iStimä system for a 6-month multi-center pilot study, were enrolled in a 3-year, long term, extension study. The performance and safety of RENOVA-iStimä system were assessed using a voiding diary and quality of life questionnaire.RESULTS: No SAEs were reported during the extended followup period. Seventy five percent (15/20) of the patients demonstrated clinical success in OAB symptoms (!50% reduction in urgent voids or leaks or normalization of voids) throughout 3 years compared to baseline. This was supported by statistically significant long-term sustainable improvement in the overall Health Related Quality of Life (HRQL) score as well as in all subscales (coping, sleeping, concern, social) and in the symptoms severity score, with 70% of the patients showing >10 points improvement (meaningful important difference) in HRQL. The majority of the patients reported being either moderately or very satisfied from the treatment throughout the 3 year follow-up (scale of "1; very satisfied" to "4; not satisfied").CONCLUSIONS: The BlueWind Medical RENOVA iStim System for the treatment of OAB demonstrates long-term safety and efficacy results as well as sustainable significant improvement in the quality of life of patients.

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Our study suggests that even at high rates of recurrence, sacrospinous hysteropexy is the most cost-effective transvaginal surgical approach for management of uterine prolapse.