Pearls & Perspectives: Navigating Evidence Gaps and Innovation in OAB Care, With Ariana Smith, MD

Welcome back to Pearls & Perspectives!

In this special Urology on the Beach edition of Pearls and Perspectives, host Amy Pearlman, MD, is joined by one of her mentors, Ariana L. Smith, MD, chief of urology at Penn Medicine, for a wide-ranging conversation on overactive bladder (OAB), evolving evidence, and the realities of translating research into patient-centered care. Recorded live from the meeting, the discussion blends clinical insight with candid reflection as Smith draws on her experience as a surgeon, researcher, and educator to unpack how guideline development, study design, and real-world practice intersect—sometimes imperfectly—in the management of lower urinary tract symptoms.

Smith and Pearlman explore how sex-based disparities in clinical research shape everyday decision-making, particularly in OAB, where much of the literature has historically centered on women while clinicians frequently extrapolate findings to men. The discussion touches on the limitations of existing outcome measures, the evolving role of lifestyle modification and pelvic floor physical therapy, and the importance of meeting patients where they are, especially as many arrive armed with information from “Dr. Google” or AI-based tools. Rather than resisting this shift, Smith emphasizes shared decision-making, patient engagement, and transparency as cornerstones of modern urologic care.

The conversation also looks ahead to innovation, highlighting emerging neuromodulation technologies, barriers to adopting new therapies, and how clinicians balance safety, efficacy, cost, and guideline alignment when integrating novel options into practice. As new American Urological Association guidelines expand flexibility around treatment sequencing, including the earlier use of minimally invasive procedures, Pearlman and Smith emphasize that the absence of a single “perfect” therapy means progress depends on thoughtful innovation, honest patient conversations, and continued investment in evidence generation. Together, they offer listeners a grounded yet optimistic perspective on where OAB management stands and where it’s headed.