The other On-Demand Course that I wanted to highlight is “The Role of Sacral Neuromodulation in Urological Practice.” I've written about the use of clinical pathways and how they apply to OAB in the past, and this course by Steven Siegel, MD, does a wonderful job of teaching how this particular aspect of the clinical pathway for OAB works. And don't underestimate clinical pathways!
Dr. Siegel's fifth slide showed his own clinical pathway for OAB. All groups should have a pathway that is followed and ideally, though I'll concede my group is not yet doing this, is monitored for compliance by all providers.
Why is neuromodulation so important? First remember that OAB is a real disease that has significant impact on our patient's quality of life and, according to one slide, only 15% of patients are still on medications for OAB at their 1-year anniversary.
Does sacral nerve modulation work? Absolutely! Dr. Siegel's data, which is broadly supported in the literature, shows a significant improvement in symptoms with few complications (60%-77% success depending on which study you read). This, like all surgeries, is very operator dependent, and the exact position of the lead matters. While I left residency thinking that I was well trained in this operation, when I joined my group, I learned we had an excellent implantor and, as a result, all of my patients are sent to him for evaluation. He tends to send me robotic cases, so we're both happy and I'm also confident our patients get better outcomes too.
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Dr. Siegel also reminded viewers that percutaneous tibial nerve stimulation works well and has been proven in a well-designed sham study. Overall, neuromodulation for the treatment of OAB in the appropriate patient as guided by clinical pathways is a prime-time technique that all of us small-town urologists should be offering our patients.
As I mentioned earlier, there are numerous other fantastic courses available through the On-Demand Course Pass. My three honorable mentions include: “Nocturia: Advances in Diagnosis and Management” (talk about a symptom I see on a daily basis!), “Nutrition Counseling for the Prevention of Urolithiasis” (great summary of dietary ways to minimize stone prevention), and “Active Surveillance for Prostate Cancer” (a great algorithm to ensure I am appropriately following these patients).
I hope everyone not only enjoyed Boston as much as I did, but also left the meeting a smarter and better urologist. For those that didn't have the chance to attend, the AUA's On-Demand course is a wonderful, cheap, and easy-to-use alternative to educate yourself on the latest updates in urology.
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