OAB and Incontinence

In this installment of the Urology Times' 50th Anniversary Innovation Celebration, Howard Goldman, MD, discusses the development of the midurethral sling as a treatment for stress urinary incontinence.

"Introducing something that with a prefashioned sling, [something] we're able to utilize with the patient in an ideal situation just under some deep sedation and local, really opened this up the ability for many more women to be treated and allowed many more physicians to be trained and to utilize this technology," says Howard B. Goldman, MD, FACS.

“Our goal was to educate these patients thoroughly on the risks and benefits of each of these therapies, and try to understand what guides their choice of third line therapy based on their lifestyle and what suits them,” says Anjali Kapur, MD.

"The devices, telemedicine and remote care, and outpatient surgery risk us losing the human connection we had with the patient, as time spent with them is at a premium today," writes Gopal H. Badlani, MD.

In this installment of the Urology Times' 50th Anniversary Innovation Celebration, Melissa R. Kaufman, MD, PhD, FACS, discusses the innovative use of stem cell–derived treatments in urologic conditions such as stress urinary incontinence.

"The newest frontier of therapy for stress incontinence is regenerative medicine and stem cell–based therapies," says Melissa R. Kaufman, MD, PhD, FACS.

"This analysis of this publication confirms the link between efficacy and the patient perception, and that the results are actually meaningful to the patients as well," says Cornelia Haag-Molkenteller, MD, PhD.

This study underscores how common urinary incontinence is in women, with nearly 1 in 5 Japanese women reporting urinary incontinence related to OAB or SUI in the last month,” said Stephanie Faubion, MD, MBA, medical director of the North American Menopause Society.

“Using a national cohort of older adults with dementia, we…found that donepezil was associated with a 13% increased risk of OAB compared to rivastigmine,” says study author Rajender R. Aparasu, PhD

“We need to understand what the treatment [means] to them as individuals, and how they perceive the benefit of the treatment,” says Cornelia Haag, Molkenteller, MD, PhD.

“This analysis of this publication confirms the link between efficacy and the patient perception, and that the results are actually meaningful to the patients as well,” says Cornelia Haag-Molkenteller, MD. PhD.

The leva Pelvic Health System showed early promise as a noninvasive therapy to alleviate symptoms of fecal incontinence in women.

“Falls are the leading cause of accidental death in seniors, and many people don’t know that having bladder control problems makes you about twice as likely to fall over,” said William Gibson, MBChB, MRCP, PhD.

The approval was based on data from the ROBUST I and ROBUST 3 clinical trials.

“New things are being developed and, I believe, at the moment showing great initiative and resolve,” says Justin Chee, MD.

“I think it's important for people to recognize this revolution that's going on, to see that we're going from what fell to why it fell,” says John O. L. DeLancey, MD.

The RENOVA iStim tibial neuromodulation system is a wireless peripheral neurostimulator device that a clinician implants in the patient’s ankle with the patient under local anesthesia.

“Men do well and they don't have a really high risk of outcomes that we don't want them to have and that patients don't want to have, which is really the need to catheterize,” says David A. Ginsberg, MD.

"The majority of patients who get onabotulinumtoxinA (Botox) don't need to use a catheter at all," says David A. Ginsberg, MD.

In a recent study, Michael A. Weber, MD, and co-authors assessed the blood pressure and heart rate profiles of the beta 3 adrenergic receptor agonist vibegron in treating patients with OAB.

"We're moving from an era where it was all based on judgment, and experience, to an era where treatments will be based on firm evidence of the structural failures present in each patient," says John O. L. DeLancey, MD.

“What our studies were looking at was a novel device that could potentially help bridge the gap between [endoscopic treatment and urethroplasty] to achieve endoscopic treatment and achieve greater success,” says Justin Chee, MD.

The FDA previously approved the Ieva Digital Therapeutic System for the treatment of urinary incontinence and pelvic floor strengthening in women.

“Doing this study allows us to say, 'With repeat treatments, we're not seeing a greater risk of retention, and we're not seeing a greater risk of UTI,'" says David A. Ginsberg, MD.

"Spend a few extra minutes to learn about emotions and voiding in your patient," writes Gopal H. Badlani, MD.

"For patients who can maintain a functional implant in-situ, long-term patient satisfaction rates remain high," said Elodie Beels, MD.

"We believed that the drug would work as well in OAB wet as it did in OAB dry, so we're pleased to see that it was statistically significantly better than placebo at the 12-week point for looking at response to both metrics in both group," says David Staskin, MD.

"I think another good take-home message is the importance of the informed consent process," says Una Lee, MD.

"As a committee, we felt that there was a need to put together a document to help field some of the ethical considerations that we run into in clinical care but have very little guidance on," says Anne M. Suskind, MD, MS, FACS, FPMRS.