OAB and Incontinence

"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.

“Qmax at 1, 3, 6, 9, and 12 months and voiding volume at 3 months were significantly lower in the impaired group than in the preserved group. This suggests that preoperative lower bladder contractility was associated with prolonged deterioration of voiding function,” says Junya Hata, PhD.

“I think the surgeon voice is an important voice to be heard because there's not a lot of avenues for surgeons to be able to be honest and share all the things they've learned and all the things they've experienced with their patients,” says Una Lee, MD, FPMRS.

In this interview, Melissa R. Kaufman, MD, PhD, FACS, describes the promise of a regenerative approach to treating recurrent incontinence in women known as autologous muscle derived cells for urinary sphincter repair (AMDC-USR).

In an effort to destigmatize urinary incontinence, Jai Seth, MD, discusses why it is important to educate the general public about this medical condition so that it can be normalized rather than stigmatized.

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.

“One of the study findings that really stood out to me was that so many of the surgeons that we spoke to are…such strong advocates for their patients,” says Wai Lee, MD.

“The take-home message is vibegron is a very safe drug and there are no concerns about any kind of cardiovascular adverse effects,” says Michael A. Weber, MD.

“The goals of [this phase of the] trial were to confirm system performance, to evaluate patient compliance, and to determine daily stimulation duration,” said Dr. Steven W. Siegel.

Daytime incontinence decreased in two-thirds of participants who performed core stability exercises.

“As health care professionals, we've got…an incredibly important role and responsibility with regards to increasing awareness and education, and then really trying to address the barriers and bring down the barriers,” says Jai Seth, MD.

“This is a successfully completed phase 3 trial in regenerative medicine in our field, and there's demonstrated safety and efficacy for women who have failed previous surgery, a very difficult group of patients for all of us,” says Michael B. Chancellor, MD.

Moderate physical activity and a greater time spent participating in moderate physical activity was associated with a decreased likelihood of stress, urge and mixed urinary incontinence in women.

“We found that in patients presenting with LUTS, there is an association between urinary incontinence and [worse] sexual function,” said study author Giuseppe Fallara, MD.

“It works on the bladder [and] it relieves the symptoms of people who have overactive bladder, but it doesn't do any adverse things to blood pressure or heart rate.” says Michael A. Weber, MD.

There was not a similar reduction in nocturnal voids among patients with a decrease in systolic blood pressure.

A decrease in urinary ATP levels following onabotulinumtoxinA (Botox) injections corresponded to clinical improvements in overactive bladder symptoms.

"Prior to this study, there was really no data on exactly how long it takes until Botox begins to take effect in the bladder," said Howard B. Goldman, MD.

The OAB symptoms, known as COVID-19–associated Cystitis, include increased urinary urgency, frequency, nocturia, and pain.

These compensatory behaviors are associated with more severe urinary symptoms and higher anxiety and stress.

In a recent study presented at the 2021 AUA Annual Meeting, Michael B. Chancellor, MD, and co-authors conducted a study that assessed the efficacy of autologous muscle derived cells for urinary sphincter repair in treating women with SUI.

“Patients want to see an improvement. They want a drug that obviously is efficacious and safe, where the side effects are low,” says David Staskin, MD.

“[These patients] have very limited treatment options and the adult muscle derived cells for sphincter regeneration represent a non-surgical means to provide very durable and effective support for these women who have suffered mightily from stress incontinence, oftentimes for long periods of time,” says Melissa R. Kaufman, MD, PhD, FACS.

“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 those metrics,” says David Staskin, MD.

“We're not saying a blanket stop for all patients, but I think we do need to be taking each patient as an individual in terms of their backgrounds,” says Jai Seth, MD.