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.

“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.

“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.

“This technology is truly a transformational opportunity for urology,” says Melissa R. Kaufman, MD, PhD, FACS.

“We are truly embarking at this moment on the next frontier in urology with these types of cellular therapies,” says Melissa R. Kaufman, MD, PhD.

Patients who received mid-urethral slings at higher-volume medical centers had a lower risk of reoperation.

Get ready for the 2021 AUA annual meeting with this preview of non-malignant topics.

“The notable feature was that the bleeding risk is very small. In our particular group, it was less than 1%,” says Jai Seth, MD.

“In terms of patients having Botox, we have to be individualized to some extent where if you feel someone's at very high risk of bleeding…then maybe you will stop the blood thinners,” says Jai Seth, MD.

“Botox to [the] bladder has, in some ways, changed the paradigm of treatment for [overactive bladder],” says Jai Seth, MD.

"By all means, educate patients about causes of nocturia, suggest behavior modifications...but don’t throw a drug at them unless there are daytime symptoms of urgency, high postvoid residual, or large volume output at night," writes Gopal H. Badlani, MD.

Twenty-six percent of patients with overactive bladder reported continence at 12 months.

The pivotal OASIS trial is examining the capability of the RENOVA iStim tibial neuromodulation system to reduce urinary urgency incontinence episodes in women.

A crude logistic regression analysis showed that adjunctive pharmacotherapy did not significantly change the odds of improving nocturia severity.

The national health insurance program is now covering Elitone, a surface-applied electrical muscle stimulation device for female stress urinary incontinence that patients self-administer at home.