Overactive bladder is a widespread medical condition affecting 16% of people globally—that's roughly 1 in 6 adults. Patients experience urgent, frequent urination that severely disrupts their daily lives, affecting work, sleep, social activities, and overall quality of life. When first-line treatments like medications fail, doctors have two main second-line options: botulinum toxin A injections into the bladder muscle, or sacral neuromodulation (a small, implanted device that sends electrical signals to control bladder function). However, there's a crucial gap in medical knowledge: doctors lack clear, evidence-based guidelines about which treatment to choose for which patient. We conducted a comprehensive study of 208 patients treated at Ghent University Hospital between 2017 and 2023. Rather than simply comparing success rates, we used advanced statistical methods called "propensity score weighting" to ensure a fair comparison. This technique mimics the conditions of a randomized clinical trial by accounting for the fact that different types of patients might be more likely to receive one treatment over another, which could skew results. Both treatments proved effective, with sacral neuromodulation showing a 62.3% success rate compared to 45.1% for botulinum toxin A. However, after applying rigorous statistical adjustments to account for patient differences, this gap narrowed considerably and was no longer statistically significant. This means that when patient characteristics are properly balanced, both treatments appear equally viable options. Our research reveals that the choice between these treatments should be individualized based on patient characteristics, preferences, and clinical factors rather than following a one-size-fits-all approach. This finding supports the development of personalized treatment strategies that could significantly improve patient outcomes and satisfaction. Improved Patient Care: This research provides evidence-based guidance helping doctors make better treatment decisions for millions affected by overactive bladder, reducing failed treatments and improving patient satisfaction. Healthcare Economics: More effective treatment selection reduces costs by minimizing unsuccessful procedures and repeat treatments, delivering substantial economic value to healthcare systems, particularly important given our aging population. Quality of Life: Better treatment outcome enable patients to participate more fully in work, social activities, and family life, keeping them productive and engaged in society while reducing the burden on families and caregivers. Advancing Precision Medicine: This work paves the way for developing personalized treatment prediction tools, moving toward precision medicine that could revolutionize overactive bladder care and inspire similar approaches in other medical conditions. Our methodological approach provides the foundation for future clinical decision-support tools that could provide real-time treatment recommendations based on individual patient profiles.