Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES

Bladder symptoms during IVF often reflect hormonal and pelvic floor changes, not infection, according to Aleece Fosnight, MSPAS, PA-C.

Aleece Fosnight, MSPAS, PA-C, identifies the 3 most consequential gaps between the 2024 AUA/SUFU OAB guideline and real-world clinical practice—clinician awareness, prescribing mindset, and payer alignment—and offers her single most important takeaway for clinicians applying this framework at the point of care.

In this video, Aleece Fosnight, MSPAS, PA-C, provides a comprehensive review of intradetrusor onabotulinumtoxinA in OAB practice, covering preprocedural counseling, dose individualization including the evidence for escalation to 200 U in refractory patients, post-void residual evaluation, catheterization risk, and the systems-level strategies she uses to sustain long-term patient adherence to retreatment schedules.

Aleece Fosnight, MSPAS, PA-C, explains how she translates the guideline's Grade A evidence for sacral neuromodulation, posterior tibial nerve stimulation, and intradetrusor onabotulinumtoxinA into individualized treatment recommendations, and describes the shared decision-making process she uses when a patient is a candidate for all 3 options.

In this video, Aleece Fosnight, MSPAS, PA-C, reviews the evidence and practical application of behavioral interventions and pharmacologic therapy for OAB, including the clinical and safety rationale for leading with beta-3 agonists over anticholinergics, and outlines how she frames the transition to minimally invasive therapy for patients who have not responded to prior treatments.

Aleece Fosnight, MSPAS, PA-C, introduces her practice philosophy and credentials, characterizes the full scope of OAB's impact on patients who go undiagnosed or undertreated, and explains what the 2024 AUA/SUFU guideline's shift away from mandatory step therapy means for patient-centered care.

Aleece Fosnight, MSPAS, PA-C, highlights the importance of tailoring contraceptive choice to symptom patterns.

When symptoms appear tied to the menstrual cycle, pharmacologic options can be used as short-term support.

Aleece Fosnight, MSPAS, PA-C, highlights pattern recognition as a cornerstone of diagnosis, encouraging clinicians to closely examine how urinary symptoms fluctuate across the menstrual cycle.

Aleece Fosnight, MSPAS, PA-C, emphasizes that timing is one of the most valuable diagnostic clues.

Hormonal changes influence fluid balance and bloating, increasing pressure within the pelvis.

Aleece Fosnight, MSPAS, PA-C, argues that incontinence must be understood as a common, treatable medical condition rather than a personal failure or an inevitable part of aging.

Once patients are ready to explore treatment, Fosnight stresses the importance of shared decision-making.

Aleece Fosnight, MSPAS, PA-C, encouraged urologists to normalize the conversation by openly acknowledging that these discussions can feel embarrassing but also by celebrating patients for taking the first step.

Aleece Fosnight, MSPAS, PA-C, highlights that although urinary leakage is common, it is not normal—and effective treatment options exist.

Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, emphasized that many older patients eventually pursue care only after years of coping, when their quality of life has been significantly affected.

Fosnight described how stigma itself becomes a barrier to care, even though effective diagnostic and treatment options are available.

Fosnight emphasizes that the cycle of shame, secrecy, and loneliness compounds the burden of urinary incontinence far beyond its physical effects.

Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, emphasizes a careful, individualized approach to managing bladder and bowel symptoms in women with a history of disordered eating.

Aleece Fosnight, MSPAS, PA-C, emphasizes that any patient presenting with urinary incontinence or related symptoms should be evaluated for pelvic floor dysfunction.

On the urinary side, Fosnight prioritizes pelvic floor physical therapy as a first-line intervention for incontinence, citing evidence of significant symptom improvement.

A key diagnostic clue is that individuals with disordered eating often have unusually precise awareness of their food and fluid intake.

Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, discusses the strong connection between eating disorders and urinary incontinence in women.