OAB and Incontinence

Experts outline their clinical approach to identifying treatment failure in patients on initial pharmacologic treatment for OAB and strategies for subsequent treatment selection.

A comprehensive discussion on clinical factors that impact pharmacologic treatment selection in patients with OAB.

Panelists introduce the available treatment modalities for OAB, including behavioral modification, pharmacologic treatment, neuromodulation, and surgical approaches.

"Despite prevalent OAB symptoms, only 6% of all LUTS prescriptions in men were for OAB medications," says Sarah Neu, MD, MSd, FRCSC.

A brief overview of how and when providers incorporate urodynamic testing as part of the diagnostic workup for OAB.

Panelists further expand on the typical clinical characteristics of patients with OAB who they see in their practice, common signs and symptoms, and potential differential diagnoses.

The UroActive device is currently being studied in the SOPHIA study, which published initial results earlier this year.

Experts begin their panel discussion on OAB by describing the typical diagnostic process and initial conversations that they have with patients suspected of having the condition.

Urologist Benjamin Brucker, MD, urogynecologist Eman Elkadry, MD, and nurse practitioner Jenna Horton, NP introduce themselves, outline their credentials, and briefly describe the patients with overactive bladder (OAB) who they typically see in their clinical practice.

UroMonitor was developed in response to conventional urodynamics, which have several limitations.

“There are a lot of social determinants of health as it relates to urge urinary incontinence,” says Joseph Kim, MD.

"It's certainly a bigger problem with advancing age in the geriatric population, and it can be a tremendous source of cost for patients who have these issues," says Gina M. Rooker, MD.

"Our main finding was that participants who experienced food insecurity in the past year were at 55% increased odds of reporting at least 1 episode of urge urinary incontinence in the past month, compared with those who have not experienced food insecurity," says Joseph Kim, MD.

The study assessed 120 women with overactive bladder for associations between anxiety and somatic symptoms, quality of life, quantitative sensory testing measures, and psychological stress symptoms.

"The improvement is sustained, but over time it does tend to decrease and we're currently trying to figure out why," says David Sheyn, MD.

Optimal bedtime was determined using the bedtime and mid-awake time for each patient, which was gathered from an Actiwatch Spectrum device.

The tool uses clinical covariates to predict changes in storage, voiding, and nocturia LUTS for patients receiving placebo, dutasteride, tamsulosin, or DUT/TAM combination therapy.

Vivally System is a neuromodulation system that uses a closed-loop control algorithm and electromyography to personalize treatment for each patient.

"After 6 months, about 77% of this group have more than 50% improvement on their main symptom," says John Heesakkers, MD, PhD.

"This is something [that is] a lot easier for the patient, it's a lot less costly to the health care system to stay out of the operating room, and it's a lot quicker for me," says Howard B. Goldman, MD.

"Not only do we lose patients and we lose this opportunity to actually take good care of them, but it actually undermines their trust in us as a profession," says A. Lenore Ackerman, MD, PhD.

"The sad thing is that with something like OAB, we already have so many barriers to getting patients in to initiate care in the first place," says A. Lenore Ackerman, MD, PhD.

"Even just the process of getting that β3 agonist is going to cost them time and energy and effort that can be quite frustrating and take a lot out of you," says A. Lenore Ackerman, MD, PhD.

"The evidence is starting to show us that although efficacy in terms of managing OAB symptoms may be equal or similar across studies for these 2 classes of medications, safety and tolerability are very different," says A. Lenore Ackerman, MD, PhD.