International Functional and Reconstructive Urology Update Archives

Implantable Tibial Nerve Stimulation (iTNS): Revi

Posted by Suzette E. Sutherland, MD, MS, URPS | Sep 2024

Suzette E. Sutherland, MD, MS, URPS, focuses on implantable tibial nerve stimulation (ITNS) for treating overactive bladder and urinary incontinence. In this 17-minute presentation, she introduces the Revi device featured in the OASIS trial.

After discussing the Revi device’s benefits, Dr. Sutherland reviews the implantation procedure and the 12-month data from the OASIS trial, which show promising results. The device is considered safe, with no serious adverse events reported. Minor issues such as discomfort were easily resolved with reprogramming, a feature of note with this device.
Sutherland emphasizes the importance of ease of use, safety, and flexibility in choosing ITNS devices. As more implantable devices enter the market, factors like surgical complexity, reprogrammability, battery replacement needs, and ongoing support will determine their success.

Podcasting Finding Your Voice – From Permission to Prominence

Posted by Kelly J. Casperson, MD | Sep 2024

Kelly J. Casperson, MD, urologist-turned-podcaster, reflects on her journey into podcasting and the power of finding one’s voice. In this 16-minute presentation, she emphasizes that podcasting isn’t just about the technical aspects—like choosing a microphone—but rather about personal growth and discovering who you truly are. Casperson’s podcast, “You Are Not Broken,” focuses on issues often overlooked in urology, such as female sexual health and menopause.

Dr. Casperson reflects on the growing podcast industry, highlighting its intimate nature and its ability to reach audiences in personal settings. She describes the evolution of podcasting from an audio-only format to a visual medium, noting YouTube’s dominance as a podcast platform. Ultimately, the presentation invites the audience to reflect on their own passions and consider ways to contribute meaningfully beyond traditional clinical work, emphasizing the importance of finding fulfillment through self-expression.

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.