Refractory OAB: How Do I Manage?
This presentation reviews implantable devices and advanced therapies for refractory overactive bladder.
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Topic: Overactive Bladder
Botulinum Toxin Type A (BoNT-A): Now and Beyond: 2025
Dr. Christopher P. Smith summarizes 25 years of experience with BoNT-A in urology, covering mechanism, dosing, and safety.
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Selective Use of Urodynamics in Lower Urinary Tract Symptoms (LUTS)
Prof. Christopher Chapple explains why urodynamics should be selective, not routine, and how bladder diaries plus targeted testing optimize care for LUTS and refractory OAB.
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Behavioral Compared with Drug Therapy for Overactive Bladder Symptoms in Parkinson’s Disease
Dr. Newman and Dr. Vaughan compare behavioral and drug therapy for overactive bladder in individuals with Parkinson’s disease.
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The New Frontier of Overactive Bladder Treatments
Katherine Amin, MD, discusses overactive bladder, its pathophysiology, prevalence, economic burden, and evolving treatment strategies.
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Urinary Incontinence (UI) and Overactive Bladder (OAB), Part 1: Prevalence & Risk Factors
Diane K. Newman, , DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, explores urinary incontinence & overactive bladder, breaking stigma and sharing key insights.
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OAB – Tier 3, Tibial Nerve Stim – eCoin
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
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
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
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
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
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.
