Which recent drug has had the biggest impact on urology?

“The big medication we have that has just been approved and I’m excited to be able to start using for patients is mirabegron (Myrbetriq) from Astellas. My practice is pretty much limited to voiding dysfunction in females, and mirabegron is the first beta-3 adrenergic agonist, which is a whole new class of medication to treat bladder overactivity.

We’ve kind of been stuck with the old anticholinergic for decades. Yes, there are newer anticholinergics with different side effect profiles, but in reality they all have the same risks and same side effects because they all act with the same mechanism.

Mirabegron has a completely different mechanism of action, with the potential to help patients who can’t tolerate the anticholinergic, whereas in the past we’ve had to say, ‘Well, if you can’t tolerate the anticholinergic, you have to go to the next level of invasiveness to manage your bladder overactivity.’ Now, we’re going to have a new tool that is really going to be able to change things.

The other medication advance that I would say is huge for us, at least in voiding dysfunction, is the ability to use onabotulinumtoxinA (Botox) effectively for bladder overactivity. That really has made a huge difference for us, having another option for patients before we go to really major surgery.”

Joel Funk, MD

Tucson, AZ

“Actually, I think you’re going to find onabotulinumtoxinA will have a profound effect on how people manage bladder instability and neurogenic bladders.

It’s only now been approved for neurogenic bladders, but they’re very close and I think within the year they’ll have it approved for instability. We’ve been one of the test sites for that, so we are quite familiar with it. I think that will have a profound effect.”

Paul Brower, MD

Laguna Hills, CA

“I can’t think of any new medications that I think will make much of a difference.

There’s always some new overactive bladder medication, but nothing stands out.

I do like the Thulium laser for BPH; I think that’s a pretty big advance. It has allowed us to surgically treat guys who have failed medication therapy very safely and effectively. Ninety percent of the time, it can be done on an outpatient basis or even in the office.

I think that’s a big advance over transurethral resection of the prostate.”

Gregory B. McCoy, MD

Portland, OR