Best of AUA 2014: Female Urology/Incontinence/ Urodynamics

July 10, 2014

Adonis K. Hijaz, MD, presents the take home messages on female urology/incontinence/urodynamics from the AUA annual meeting in Orlando, FL, including studies on mesh outcomes and the overactive bladder treatment mirabegron (Myrbetriq).

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• Multiple studies examined mesh outcomes. In patients who underwent removal of vaginal mesh or synthetic suburethral tape for pain, visual analog scores dropped from 7.9 to 0.9 after surgery in the mesh group and from 5.3 to 1.5 in the tape group. Pain-free status was achieved in 67% of the mesh group and 81% of the tape group. Another study reported that 69% of patients who underwent mesh removal for exposure presented with dyspareunia, which decreased to 15.5% at 3 months. A retrospective review of 229 patients undergoing transvaginal mesh revision found that 73% reported either improvement or resolution of pain, but patients with a history of chronic pelvic pain were at increased risk of no improvement or worsening of pain.

• The Multidisciplinary Approach to the Study of Chronic Pelvic Pain identified objective and reproducible characteristics that distinguished patients with Urologic Chronic Pelvic Pain Syndrome from individuals without pain. There is also evidence of two clinical phenotypes that correlate with symptom pattern over time: a centralized or systemic phenotype that affects 74% of the cohort and a bladder-specific phenotype that affects 26% of the cohort. Researchers have also identified a target group of biomarkers that would need to be substantially evaluated on phase II study.

• Five-year data for retropubic and transobturator sling surgery for the treatment of urinary incontinence were presented from the extended Trial of Mid-Urethral Slings (E-TOMUS). There was no significant difference in success rate between the slings over time. Treatment success for retropubic slings was 7.9% higher than for transobturator slings and did not meet the criteria for equivalence. Overall satisfaction rate was similar at 5 years between the two groups.

• Using data from the Stress Incontinence Surgical Treatment Efficacy Trial and TOMUS, researchers reported that 60% to 70% of patients undergoing stress urinary incontinence surgery who had preoperative OAB symptoms experienced improvement in symptoms at 12 months, although the initial improvement diminished over time. Urodynamic parameters did not predict a change in OAB symptoms.

• Two phase II studies evaluated urinary retention in patients taking mirabegron (Myrbetriq) alone or in combination with solifenacin (VESIcare) for overactive bladder. The first study, which evaluated the combination therapy, found urinary retention in 0.2% of patients, with elevated post-void residual in 0.5%. The second study, which evaluated mirabegron monotherapy for lower urinary tract symptoms and bladder outlet obstruction, found that urinary retention was absent from all treatment groups except placebo and mirabegron, 100 mg.

• Repeated onabotulinumtoxinA (Botox) injections for OAB and urinary incontinence consistently reduced urge incontinence episodes per day at 12 weeks. Duration of effect remained stable at 24 to 36 weeks between each injection cycle.

• In a 5% national random sample of Medicare patients, out of 3.1 million patients with a diagnosis that could potentially be treated with sacral neuromodulation, 0.46% of patients underwent the procedure. However, the usage of modulation significantly increased from 0.02% to 0.75% over a 10-year period.

• An evaluation of urodynamics variables as predictors for success of sacral neuromodulation found no correlation between any urodynamics parameter and successful neuromodulation outcome.

• Patients with urinary urge incontinence and/or urgency frequency undergoing sacral neuromodulation were more likely to have 12-month therapeutic success if they had greater reduction in the number of leaks at test stimulation. Success was also more likely for urinary incontinence patients if they had previously tried one or two OAB medications, compared with trying three.UT

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