Topic: Overactive Bladder

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.

OAB – Tier 3, SNS – Interstim

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

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

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

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

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.

Overactive Bladder in the Male Radiated Patient: What Works

by O. Lenaine Westney, MD | May 2023

O. Lenaine Westney, MD, explores managing overactive bladder (OAB) in male patients who have undergone radiation therapy.

Management of Refractory OAB Patient: Insights from a 20-year Experience Using Advanced OAB Techniques

by Christopher P. Smith, MD, MBA, MSS | Mar 2023

Christopher P. Smith, MD, MBA, MSS, discusses management of overactive bladder (OAB), drawing on 20 years of clinical experience.

Overactive Bladder vs. Interstitial Cystitis: Overlapping Conditions?

by John Thomas Stoffel, MD | May 2022

John Thomas Stoffel, MD, Associate Professor of Urology and Chief of the Division of Neurourology and Pelvic Reconstruction within the University of Michigan Department of Urology in Ann Arbor, Michigan, discusses how to differentiate overactive bladder (OAB) from interstitial cystitis (IC), as well as how to appropriately treat both conditions. He begins with some background, explaining that OAB is common and affects 30 to 50 million women worldwide. IC is also common, and may affect between 2 and 17% of US adults. Dr. Stoffel argues that despite this prevalence, clinicians do not understand the depth of these conditions nor how to differentiate them. He then defines OAB as “[urinary] urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia,” whereas IC is an unpleasant sensation (pain, pressure, discomfort) perceived to be related in the urinary bladder, associated with LUTS, of greater than 6 weeks duration in the absence of infection. Dr. Stoffel posits that IC is more associated with sensory symptoms while OAB more associated with motor symptoms. He then discusses the work-up for OAB and IC, explaining that the work-up for the former should include a physical exam, urine analysis, and a voiding diary, while the work-up for the latter should feature a physical exam, a history of symptoms, urinalysis, urine culture, and urine cytology. Dr. Stoffel moves on to treatment strategies, describing the treatment of OAB as like a ladder, moving sequentially from behavioral therapy to medications to neuromodulation/onabotulinum toxin. He recommends tracking outcomes for OAB with patient reported outcome measures (PROMS), and highlights the effectiveness of behavioral therapies such as timed voiding/fluid management, weight loss, and biofeedback. Dr. Stoffel also notes that there are no clear winners among OAB medications, and he emphasizes the need to define patients’ expectations. He describes the treatment strategy for IC as less like a ladder than a grab bag, explaining that “initial treatment type and level should depend on symptom severity, clinician judgment, and patient preferences.” Dr. Stoffel briefly considers the evidence for neuromodulation and onabotulinum toxin, concluding that they are effective for OAB, but there is little extended data in IC.

Overactive Bladder (OAB) / Urge Urinary Incontinence (UUI) & the Urinary Microbiome

by Nazema Y. Siddiqui, MD, MHSc | Jul 2020

Nazema Y. Siddiqui, MD, MHSc, Associate Professor of Obstetrics & Gynecology at Duke University, discusses studies that investigate the urinary microbiome and its links to overactive bladder (OAB) and urge urinary incontinence (UUI). She specifically identifies BMI, age, and estrogen levels as leading potential variables for predicting a patient’s urinary microbiome, and posits that longitudinal studies and computational models to better understand the microbiome will be necessary to make this knowledge useful for treatment and diagnosis of OAB and UUI in the future.

Geriatric Considerations in Urinary Incontinence and Overactive Bladder (OAB)

by Una Lee, MD, FPMRS | Apr 2020

Una Lee, MD, FPMRS, a urologist at the Virginia Mason Medical Center, discusses concepts physicians should consider when managing urinary incontinence and overactive bladder (OAB) in geriatric populations. First, Dr. Lee reviews the “5 M’s”: mind, mobility, medications, multi-complexity, and what matters most to the patient, or care goals/preferences. Additionally, she addresses the role of frailty in older adults, which is associated with increased risk of poor health outcomes. Lastly, she reviews data about the association of anticholinergic medication use and dementia.

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