OAB and Incontinence

Expert panelists review the AUA/SUFU guidelines for overactive bladder (OAB) treatment, discussing first-line behavioral strategies and the transition to pharmacological treatments.

Dr. Kennelly, Dr. Kevin Benson, and Dr. Karyn Eilber delve into the significant impact of OAB on patients' quality of life, including its effects on daily activities and mental well-being, and how this burden shapes clinical decisions in the early stages of treatment and selection of appropriate therapeutic options.

"In general, the majority of patients were very satisfied with the treatment," says Nitya E. Abraham, MD.

The real-world study plans to enroll 500 patients who are utilizing the Leva Pelvic Health System, a non-invasive medical device to help women train and strengthen pelvic floor muscles.

"I think some of the biggest advances have come in the surgical space," says Vikas Desai, MD.

“I definitely am more careful about who I offer Botox to in men,” says Gina M. Rooker, MD.

Clarius Bladder AI ultrasound software may have significant utility in acute care settings, urology clinics, and nursing homes.

"What we found was that the primary outcome didn't change. Whether you had access to eADVICE or you didn't, most people still wanted to see the specialist at the end of their time, including people who were already dry," says Patrina H. Y. Caldwell, BMed, FRACP, PhD.

"The reason we did this study was that in Australia, there are usually very long waiting times to be seen in the continence service," says Patrina H. Y. Caldwell, BMed, FRACP, PhD.

"There is a real importance for qualitative research and understanding the patient's experience and voice whether it's incontinence or any other condition," says Lindsay A. Hampson, MD, MAS.

"PLUS was created to start laying down the foundation for implementing prevention science, and understanding things that helped maintain bladder health [and] things that are risk factors for progression into bladder disease," says Leslie Rickey, MD, MPH.

The coverage policy went into effect on December 28, 2023.

"Ask about leakage and talk about options," says Lindsay A. Hampson, MD, MAS.

"I think as urologists that treat incontinence, both Dr. Shaw and I probably have the experience of talking to many men who actually never pursue surgical treatment for their incontinence, but they still want to understand what the options are," says Lindsay A. Hampson, MD, MAS.

"I think the main [finding] that continues to strike me working with Dr Hampson on this type of work is how different individual incontinence is for the patient who is experiencing it," says Nathan M. Shaw, MD.

“[We can use] the study to help further those arguments that we should be able to make our clinical decisions based on the patient's presentation, a risk-benefit discussion between patient and physician, and not based on what insurance companies will pay for,” says Michelle E. Van Kuiken, MD.

"We found that less than 5% of people with incontinence had received a surgical intervention for their incontinence within a year of the survey," says Giulia I. Lane, MD, MS.

“Probably one of the most meaningful findings was that insurance type did influence the choice of medication first prescribed by urologists for overactive bladder,” says Michelle E. Van Kuiken, MD.

“The main rationale for this research was we felt like there was an unaddressed population of patients living with urinary incontinence,” says Nathan M. Shaw, MD.

In this Urology Times® episode, Dr. Kennelly, Dr. Kevin Benson, and Dr. Karyn Eilber discuss overactive bladder (OAB), focusing on its diagnosis, symptomatology, and patient populations most at risk, including gender and age-related factors.

All of those enrolled in the study have been implanted for at least 7 months, with the longest implantation at 15 months.

According to Neuspera, results from phase 2 of the SANS-UUI trial are expected to support an application for FDA approval of the device in patients with OAB-related UUI.

"This work and previous work supports the idea that EBV not only causes MS, but also continues to affect disease progression," write the authors.

The phase 2a open-label dose ascending study to assess the safety, tolerability, and efficacy of VMB-100 in female patients with moderate SUI is expected to begin in the first half of 2024.

"Overactive bladder symptoms have been shown to be influenced by these other areas in their life that can create a lot of stress and problems," says Raveen Syan, MD, FPMRS.

“Providers can use this information to counsel patients that that initial sticker shock goes away once you stick with that medication,” says Katherine Shapiro, MD.

Experts close their panel on OAB by identifying treatment pathways for patients who have an unsatisfactory response to third-line therapy.

“When you're talking about Medicare patients who are on multiple medications, and this is not the only thing that they're taking, to pay over $100 for 1 medication is sometimes not possible,” says Katherine Shapiro, MD.

These findings may help guide decision-making in the initial testing phase of the [sacral neuromodulation] device prior to permanent implant or explant, according to Bradley Gill, MD, of the Cleveland Clinic.