OAB and Incontinence

Over half of patients stop intradetrusor botulinum toxin injections within 10 years, mostly due to lack of clinical efficacy, researchers say.

In this interview, J. Quentin Clemens, MD, discusses the work being done by the MAPP (Multidisciplinary Approach to Chronic Pelvic Pain) Research Network and LURN (Symptoms of Lower Urinary Tract Dysfunction Research Network) research initiatives.

“The results suggest that this compound has rapid efficacy and a favorable safety profile in patients with nocturia due to nocturnal polyuria,” says researcher Diane Newman, DNP.

Cost-effectiveness results favored botulinum toxin at 2 years as well as in an analysis at 5 years accounting for increased cost of the botulinum approach due to repeat injections, according to investigator Heidi S. Harvie, MD, MSCE.

In women with mixed urinary incontinence, a combined conservative and surgical treatment approach provided significant improvements versus surgical treatment alone.

Among patients with a clinical response 1 month after implantation, most went on to have clinically and statistically significant reductions in overactive bladder symptoms at 1 year.

Researchers retrospectively reviewed the records of a series of patients who underwent onabotulinumtoxinA (Botox) injections for overactive bladder from 2007 to 2017.

Nocturnal polyuria can't be diagnosed using a standard history alone, researchers say.

A comparison of autologous fascial pubovaginal and synthetic midurethral slings and a study examining onabotulinumA (Botox) injections in the elderly population were among other female urology take-homes from AUA 2018.

“There is apparent promise here. There appears to be stability of results in those patients followed up over time,” says researcher Roger Dmochowski, MD.

It appears that many patients who have a good response to initial injections and subjective improvement fail to return for subsequent injections.

OnabotulinumtoxinA (Botox) appears to increase the activity of brain regions involved in sensation and processing of urinary urgency in female patients with neurogenic overactive bladder, says Rose Khavari, MD.

Among 321 scheduled telemedicine visits for patients with neurogenic bladder, the compliance rate was 91%.

Analyses with patients stratified into three groups by age showed that an emulsified microdose desmopressin acetate nasal spray (Noctiva) consistently extended the first uninterrupted sleep period in a clinically meaningful manner for patients of all ages.

“Unless there’s a contraindication, they have to try medications. ‘I don’t feel like taking it’ is not failing a medication,” says one urologist.

Attorneys will scour for online ‘dirt’ to use in a lawsuit, writes Brianne Goodwin, JD, RN.

Modifier use without supporting documentation could be considered fraudulent, write Ray Painter, MD, and Mark Painter.

Data from a recent study also indicate that overactive bladder patients discontinue pharmacotherapy long-term despite chronic symptoms.

Until now there has been no large, thorough investigation into the risk of clean intermittent catheterization in patients undergoing repeat injections of onabotulinumtoxinA.

"Concerns about scope of practice aside, there is no doubt that as the demand for urologic services increases and the number of practicing urologists decreases, we will need to find alternative ways to continue to see and treat our patients," writes Henry Rosevear, MD.

The oral beta-3 agonist vibegron, taken once daily at either 50 mg or 100 mg, is well tolerated and results in clinically and statistically significant reductions in daily micturitions, urge incontinence, and urgency episodes.

A nickel-sized leadless titanium device, implanted in patients’ ankles, could provide years of relief from overactive bladder syndrome.

In this article, we review the underlying causes of nocturia and outline an approach to its diagnostic evaluation and treatment.

Researchers have reported an association with the release of the AUA/SUFU Adult Urodynamics Guideline and reduction of urodynamics performed for diagnosis of overactive bladder, stress urinary incontinence, and mixed urinary incontinence.

General urologists are less likely to utilize third-line interventions for overactive bladder than those with additional female pelvic medicine and reconstructive surgery training.

The physician argued that the migration of the mesh is a known risk of the procedure and the patient had given informed consent for the operation.

"It’s absolutely important. Because we have so much overlap in our patient population, our patients are best served by us working together," says one urologist.