Topic: Incontinence

Non-surgical Modalities for Pelvic Floor Disorders

by Oscar A. Aguirre, MD | Nov 2024

Oscar A. Aguirre, MD, discusses managing female stress urinary incontinence and related pelvic floor issues, including non-surgical treatments. In this 11-minute talk, Aguirre notes a shift away from surgeries as non-invasive options have proven effective in alleviating urinary symptoms.

Dr. Aguirre began using laser treatments for vaginal tightening in 2013, which unexpectedly improved patients’ sexual function, lubrication, and incontinence. Over time, these experiences revealed the utility of various non-surgical options, including radiofrequency and platelet-rich plasma (PRP) therapies, for enhancing both sexual health and urinary symptoms. He emphasizes that these treatments, though not FDA-approved for incontinence, have shown promising results in improving symptoms without invasive intervention.

Emerging Therapies for Female SUI – Myosites, ACT

by Michael P. Feloney, MD | Oct 2024

Michael P. Feloney, MD, focuses on Adjustable Continence Therapy (ACT) for women, specifically dual-balloon adjustable continence therapy. Dr. Feloney is noted for his experience with ACT, particularly during the initial investigational trials in the early 2000s. In this 12-minute presentation, Dr. Feloney describes the implantation procedure and provides photographs and graphics illustrating the correct placement of the silicone elastomer balloons.
A notable feature of this therapy is its adjustability. Once the balloons are in place, adjustments can be made post-operatively in the office, allowing for fine-tuning based on the patient’s response. Feloney emphasizes this advantage and its potential to enhance improved continence.
Dr. Felony addresses complication rates and notes that the rates of intraoperative perforations decrease with increased experience. The therapy, currently approved in Europe, Canada, Australia, and New Zealand, shows promise as a minimally invasive option for women with recurrent stress urinary incontinence who have failed previous surgeries.

Female Stress Urinary Incontinence 2023

by Brian J. Flynn, MD | Oct 2024

Brian J. Flynn, MD, provides a comprehensive update on managing female stress urinary incontinence (SUI) as of 2023. His 24-minute presentation meticulously reviews the latest advancements in both diagnostic and therapeutic approaches.

Dr. Flynn compares the advantages and disadvantages of current treatment options for SUI, including bulking agents, TVT, MUS, and TOT. While mid-urethral slings remain the gold standard for treatment, Dr. Flynn highlights emerging alternatives, including adjustable slings and ACT, which offer tailored solutions for patients with varying degrees of SUI.

Dr. Flynn stresses the importance of individualized treatment planning, which considers patient preferences, comorbidities, and previous surgical history when choosing a treatment plan to optimize patient outcomes.

Early Continence Recovery after Robotic Assisted Radical Prostatectomy: The Role of Prostatic Shape

by Pierluigi Bove, MD | Oct 2024

Pierluigi Bove, MD, explores the role of prostatic shape in continence preservation and recovery after robotic-assisted radical prostatectomy (RARP). Dr. Bove begins with a review of the key preoperative anatomical landmarks and how they inform surgical strategy.

Dr. Bove presents data supporting the relationship between preoperative Membranous Urethral Length (MUL,) bladder neck preservation, prostatic shape, and continence recovery post-RARP. He notes that preserving as much of the MUL and bladder neck as possible led to significantly higher rates of continence. Additionally, he notes that prostates with no membranous urethral overlap, or “apple-shaped” prostates, had the best urinary continence recovery.

Dr. Bove concludes by presenting video examples of RARP surgical strategies which preserve/ promote continence recovery. He presents common complications during RARP and examples of how his institution has compensated for them.

OAB – Tier 3, Tibial Nerve Stim – eCoin

by Jason M. Kim, MD | Sep 2024

Jason M. Kim, MD, introduces the eCoin device, a small, 2.3-centimeter implant used for tibial nerve stimulation to treat bladder control issues. In this 8-minute presentation, Dr. Kim briefly overviews the eCoin implantation kit and procedure.
Dr. Kim praises the high quality of the kit and ease of implantation. The process takes around five minutes, with the majority of the time spent ensuring a secure three-layer closure.
Kim shares the device’s effectiveness, with 75% of patients experiencing significant symptom relief after one year. His presentation concludes with a discussion on patient preferences, comparing the eCoin implant with traditional options like Botox and sacral neuromodulation.

Implantable Tibial Nerve Stimulation (iTNS): Revi

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.

Urodynamics Review

by Stephen R. Kraus, MD, MBA, FACS | Sep 2024

Stephen R. Kraus, MD, MBA, FACS, provides a comprehensive review of urodynamics, discussing key concepts and practical applications in evaluating lower urinary tract function. This 14-minute presentation emphasizes the importance of understanding both the storage and emptying phases of bladder function.

Dr. Kraus details how dysfunction can arise from a bladder issue, an outlet problem, or both. Specific examples are given and complex cases are also included. Kraus notes results from various tests, such as those for stress incontinence, overactive bladder, and neurogenic bladder, help guide the use of urodynamics in clinical practice. He highlights the need for careful interpretation of test results to ensure accurate diagnosis and treatment planning.

SUI – AUA/SUFU Guidelines 2017 — Amendment 2023

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

Suzette E. Sutherland, MD, MS, URPS, discusses the AUA and SUFU guidelines for evaluating and treating stress urinary incontinence (SUI). In this five-minute talk, Dr. Sutherland reviews the five key components for evaluating a patient with SUI and discusses indications for advanced diagnostic tools such as cystoscopy and urodynamics.
Dr. Sutherland’s discussion continues with the Guideline’s treatment options, both non-surgical (pessaries, vaginal inserts, and pelvic floor muscle exercises), and surgical (bulking agents, midurethral slings). The recent amendment to the guidelines now allows clinicians to offer single-incision slings alongside retropubic and transobturator slings for patients, reflecting their comparable safety and effectiveness.

Female SUI: Bulking

by Alexandra Rogers, MD | Sep 2024

Alexandra Rogers, MD, focuses on female stress urinary incontinence and treatment options. In this 12-minute presentation, she begins by reviewing updates in the American Urological Association (AUA) guidelines for treatment options.

Dr. Rogers discusses slings, a longstanding treatment since 1998, which remain effective. Rogers also highlights the growing popularity of bulking agents, particularly the polyacrylamide hydrogel approved in 2020, noting its safety and repeatability. As a less invasive alternative that can be performed in an office setting, bulking agents offer an acceptable risk-benefit ratio for many patients, especially those hesitant to undergo invasive procedures.
Rogers discusses the importance of offering multiple treatment options to those with SUI, with a focus on minimizing complications and recovery time.

Contemporary Management and Prevention of Artificial Urinary Sphincter Erosion

by Jeffrey Loh-Doyle, MD | Sep 2024

Jeffrey Loh-Doyle, MD, provides a detailed analysis of artificial urinary sphincter (AUS) erosion, focusing on its causes, risk factors, management, and prevention. In this 18-minute presentation, Dr. Loh-Doyle examines this complication of the gold standard treatment for moderate to severe male stress urinary incontinence.
Dr. Loh-Doyle stresses the importance of identifying and managing AUS erosion. Patients may present with symptoms such as worsening incontinence, perineal or scrotal swelling, or, in more subtle cases, no symptoms at all. Cystoscopy is necessary to confirm erosion, especially in cases of severe discomfort or urinary retention. He discusses treatment, which involves removing the AUS device, draining the bladder with a catheter, and, depending on the severity of the erosion, repairing the urethra.
Prevention is key, especially in high-risk patients. Loh-Doyle advocates for conservative management, including using lower-pressure balloons, delayed activation, and educating patients on deactivating the device to reduce compressive forces. He also shares that, while AUS is effective, repeated erosions increase the likelihood of poor outcomes.

Emerging Therapies: Autologous Derived Muscle Cells

by Christopher E. Wolter, MD | Sep 2024

Christopher E. Wolter, MD, discusses using autologous muscle-derived cells as a promising treatment for stress urinary incontinence.

In this 7-minute talk, Dr. Wolter reviews the steps for the therapy procedure, which involves procuring muscle cells through a minimally invasive biopsy, expanding the cells in culture, and re-injecting them into the patient. He notes that stress urinary incontinence is considered an ideal target for this therapy.
Wolter shares the promising results from Initial studies, including a pilot trial in 2008. Later trials using higher doses of injected cells demonstrated even better outcomes. He also references the MYOCYTE trial, a large multicenter, multi-institutional randomized study, which suggested that patients with previous stress incontinence treatments, such as slings, respond better to the therapy.

Single Incision Slings

by Jason M. Kim, MD | Sep 2024

Jason M. Kim, MD, discusses single-incision slings, a less invasive option for treating stress incontinence in women. In this 9-minute presentation, Dr. Kim offers single-incision slings as a less invasive option than traditional retropubic and transobturator slings, eliminating many of the complications associated with traditional methods. He begins with a short background of midurethral slings, including possible complications and why a single incision option would be preferable.
Dr. Kim discusses the benefits of the single-incision sling and shows examples of possible options. He asserts that this less invasive therapy eliminates many complications associated with traditional methods. He also shares studies that have demonstrated its efficacy, including the 2022 Cochrane review and a randomized trial published in The New England Journal of Medicine.

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