Video Archives

OAB – Tier 3, SNS – Interstim

Posted by Christopher E. Wolter, MD | Sep 2024

Christopher E. Wolter, MD, focuses on sacral neuromodulation (SNM), specifically InterStim, and its role in treating voiding dysfunction. In this 11-minute presentation, Wolter outlines the historical development of neuromodulation, emphasizing SNM’s effectiveness compared to medications. It also offers the potential to manage fecal incontinence, neurogenic bladder dysfunction, and even interstitial cystitis in some cases.
Dr. Wolter discusses the operative approach for SNM placement, highlighting the importance of proper technique. He illustrates the procedure with photographs and x-rays, providing step-by-step instructions and suggestions to ensure a successful outcome.

OAB – Tier 3, Botox

Posted by O. Lenaine Westney, MD | Sep 2024

O. Lenaine Westney, MD, focuses on the challenges of managing overactive bladder (OAB) in post-prostatectomy patients, particularly those who have undergone radiation therapy. In this 13-minute presentation, Westney explains that while most patients with localized prostate cancer return to baseline urinary function after treatment, a significant subset experiences long-term urinary symptoms. Adding radiation increases the incidence and severity of OAB symptoms.
Dr. Westney explains the AUA management guidelines for OAB, which lack specific recommendations for men treated for prostate cancer, highlighting the need for better data. She discusses various treatment approaches, including pharmacological options, pelvic floor exercises, and neuromodulation, but notes the scarcity of research in this patient population. Botulinum toxin and sacral nerve stimulation show promise but require further investigation.
Dr. Westney shares a case of a 67-year-old man treated with salvage prostatectomy and radiation. Despite interventions like artificial urinary sphincter (AUS) and botulinum toxin, his symptoms persisted. His case illustrates the challenges involved in treating these patients.

OAB – “Tier 2” Management

Posted by Alan J. Wein, MD, PhD (hon), FACS | Sep 2024

Alan J. Wein, MD, PhD (hon), FACS, explores the pharmacological management of overactive bladder (OAB), focusing on antimuscarinic medications and beta-3 agonists. In this 13-minute presentation, Wein stresses the importance of setting realistic treatment goals for patients, as no current therapy cures OAB but can manage symptoms. He recommends combining behavioral and drug therapy to achieve better outcomes.
Wein discusses antimuscarinic, anticholinergic, and Beta-3 agonist medications in detail. The efficacy of these drugs varies. Overall, while both drug classes offer benefits in managing OAB, the choice of therapy should consider side effects, patient age, and cognitive risks. His presentation concludes with the recommendation that beta-3 agonists may be a safer first-line therapy due to their favorable side-effect profile.

Non-Invasive Therapies for OAB

Posted by Janine L. Oliver, MD | Sep 2024

Janine L. Oliver, MD, focuses on updated treatment approaches in non-invasive therapies for overactive bladder (OAB). In this 9-minute presentation, Oliver discusses abandoning the previous step-therapy model and now highlights a broader range of non-invasive options.
Oliver discusses the new guideline category of non-invasive therapies requiring active patient participation. Of particular interest are stimulation therapies such as transcutaneous tibial neuromodulation (TTNS) and magnetic stimulation, which offer non-invasive, at-home treatment options. While non-invasive therapies remain crucial in OAB management, Oliver emphasizes the need for more research into these novel approaches. These therapies hold promise but require further exploration to optimize patient outcomes.

Overview of Axonics SNM Therapy: A Community-Based Perspective

Posted by Matthew C. Ercolani, MD, FACS | Sep 2024

Matthew C. Ercolani, MD, FACS, highlights the importance of sacral nerve modulation (SNM) in treating patients with urinary and fecal incontinence, particularly in rural or community-based settings where access to tertiary care is limited. In this 10-minute presentation, Ercolani, a robotic cancer surgeon, emphasizes that while SNM has been available since 1997, many patients remain unaware of its benefits. He considers SNM especially useful in remote areas, as it provides long-term relief for patients without requiring frequent follow-up.
Dr. Ercolani reviews the procedure for SNM therapy, emphasizing the importance of precise surgical techniques. He provides suggestions for the most successful implantation procedure, including fluoroscopy, proper lead placement, and doctor education on sacral anatomy. The presentation also underscores the importance of comprehensive clinical support, which ensures patients understand how to manage their devices post-surgery.