OAB and Incontinence

Dr. Kennelly, Dr. Kevin Benson, and Dr. Karyn Eilber discuss the goals and assessment methods for overactive bladder (OAB) pharmacological treatments, including how they monitor and address refractory or nonresponsive cases. They explore the real-world rates of medication failure, particularly with anticholinergics, and delve into the decision-making process behind considering alternative therapies, focusing on factors that prompt a change in treatment, especially for specific patient populations. The discussion includes insights on when and why to shift from standard OAB medications to other therapeutic options.

In this episode, experts review safety concerns, drug interactions, and common adverse effects (AEs) associated with overactive bladder (OAB) medications. They discuss the impact of AEs like constipation, hypertension, and dry mouth on patient quality of life, strategies for managing these effects, and circumstances warranting a change in treatment. The experts also examine recent clinical evidence linking anti-cholinergic treatments to an increased risk of dementia in older patients, discussing its implications for clinical practice and strategies for urologists to remain vigilant about such safety concerns.

Experts explore the clinical benefits and limitations of standard pharmacological options, like anti-muscarinic agents and beta-3 adrenergic agonists, and share their preferences and experiences in selecting and managing treatments for OAB, focusing on the effectiveness and patient-specific considerations in their clinical practice. In this episode, Dr. Kennelly, alongside Drs. Eilber and Benson, discusses the transition to second-line therapies for overactive bladder, focusing on medication classes like anticholinergics and beta-3 agonists. They explore patient-centered considerations such as medication compliance, cost, insurance coverage, and the chronic nature of overactive bladder management, emphasizing individualized treatment based on patient needs and health profiles.

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.