In this episode of BackTable Urology, Dr. Jose Silva and Dr. Suzette Sutherland, director of Female Urology at the University of Washington, discuss new therapies for overactive bladder (OAB).

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SHOW NOTES

First, they describe the symptoms of OAB which include an increased frequency and urgency of urination, sometimes leading to urinary incontinence. Conservative measures include pelvic floor exercises, diet, and lifestyle changes. If patients fail conservative measures, urologists can prescribe anticholinergics. However,beta agonists are preferable because they do not cross the blood-brain barrier. Then. the doctors briefly chat about the use of these agents in Alzheimer disease patients as well, which may be dependent on insurance approval.

Next, Dr. Sutherland summarizes surgical devices to treat OAB and the clinical trials supporting each of them. Sacral nerve neuromodulation is a device that has been on the market for years, but newer models that include fixed and rechargeable batteries are starting to become more available. Additionally, the Neuspera is a sacral nerve neuromodulation that operates wirelessly through Bluetooth. The doctors also compare the two existing models of sacral neuromodulation (Medtronic vs. Axonics).

One newer surgical treatment is tibial nerve stimulation, and Dr. Sutherland summarizes her placement technique, voltage settings, intraoperative testing, and the importance of a healthy ankle evaluation prior to placing the device. promising results, in-office, sedation, healthy ankle evaluation. She also notes that repositioning the leads in sacral and tibial neuromodulation in a followup visit may be necessary. Finally, she shares about Fempulse, vaginal stimulator mimicking a pessary, that is still being tested in research trials.

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