Dr. Vikas Desai on recent advances in incontinence/OAB treatments

Opinion
Video

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

In this video, Vikas Desai, MD, discusses recent advances in the treatment of urinary incontinence and overactive bladder. Desai is a urologist with Northwestern Medical Group in Winfield, Illinois.

Transcription:

What have been some recent advances in the treatment of urinary incontinence?

I think some of the biggest advances have come in the surgical space. I think starting again, with stress incontinence, it used to be conservative stuff is very much the first line for any type of urinary issue, which is behavioral management or exercises. For females with stress incontinence, one of the most common types of exercises you'll hear about is Kegel exercise, strengthening the pelvic floor muscles, working with a physical therapist who can really pinpoint specific exercises, or maybe teach you how to do exercises that are going to be more impactful. Everyone can do Kegels if you look on the internet, but you might not be targeting the muscles as effectively as maybe going to a physical therapist. They can also do something like biofeedback. That kind of gets into my advances where, let's say those don't help, or if you're just leaking a lot, that conservative management is not going to be great. When I mean leaking a lot, I would say maybe more than 2 pads a day that are just getting soaked, sometimes also weight. If you're overweight, and you're leaking more than 2 pads a day, the conservative stuff [isn't going to work]. One of the most recent advances that I would say in the last 1 to 2 years has been something called Bulkamid. It's a bulking agent. Bulking agents have been around for a long time in the stress incontinence space, but they used to be particulate bulking agents; some of the common brands in the past were Coaptite or Durasphere, and they would kind of erode through the tissue, so they would erode through the urethra. They weren't as durable. Before Bulkamid came around, I hadn't done a bulking agent in years. I'd seen it in training a few times in elderly patients where surgery wasn't an option, or they just want something done. But the durability of those agents was about 50%; it just wasn't effective. Bulkamid, on the other hand, is a non particulate, or water-based product. It's an implant, but it can be done right in in the office where we're basically putting cushions where the urethra is wide open, to go ahead and bulk that urethra. And so that itself, is minimally invasive, where we can get patients to be about 80% improved over 5 to 7 years, and there are some longer studies out there as well. In the overactive bladder, or urinary urge incontinence space, I think one of the newer things that has come out—it's been around for a while, but the advance was that it became MRI safe—is sacral neuromodulation. Sacral neuromodulation is an implantable battery. I would say it's like a bladder pacemaker, where the device that actually was being implanted, which is a lead that targets the nerve that controls the bladder, and the battery itself, they weren't MRI safe. Now, they're MRI safe. The battery itself used to have a 5- to 7-year lifespan [and] now has about a 15- to 20-year lifespan. Additionally, it's a procedure that can be started off in the office with something called a basic evaluation. If that basic evaluation proves successful in improving someone's symptoms by 50%, then we can do a procedure in the operating room that takes about an hour, hour and a half. And they have this battery, that for some people, is probably going to last them a lifetime. Another thing that's coming out and we're going to be running the clinical trial probably in the spring is something called Revi, which is an implantable device, which basically takes on the framework of something called PTNS, which is percutaneous tibial nerve stimulation. This is a basically an implantable device behind the tibial nerve done in the operating room through about a 20-, 30-minute procedure. This device itself right now can last 10 years, but there's no battery that you have; there's no other implantable thing besides this 1 little incision about, I would say several centimeters where we're putting this implantable thing. You have this wearable device, almost like an ankle bracelet - you don't have to wear it all the time - but just to kind of help charge the device and that's something similar to the sacral neuromodulation. So I think this Revi, which is by Blue Wind, which is an implantable PTNS device, can provide another procedure in the armamentarium where if patients don't want something like a bigger surgery, something like a smaller surgery could be something I would say.

This transcription was edited for clarity.

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