Benign Conditions

Benign Prostatic Hyperplasia

Bladder Cancer

Female Urology

Genitourinary Cancers

Genomic Testing

Hormone Therapy

Kidney Cancer

Challenging Anatomy

Innovative Techniques

Laser Lithotripsy

PCNL Tech & Devices

Ureteroscopy Tech & Devices

Kidney Stones

Men's Health

Next-Generation Imaging

Voiding Dysfunction

OAB and Incontinence

Pediatrics

Controveries in Urologic Cancer

Drug Therapy

Prostate Cancer

Sexual Dysfunction

UTUC

Cosmetic Surgery

Urologic Surgery

Business

Practice Management

Malpractice Consult

Health Law & Policy

Media

Case-Based Peer Perspectives

Investigator Perspectives 

Medical World News

Podcasts

Urology Medical Perspectives

UTv Videos

Peer Exchange

News Network

Virtual Tumor Board

Insights

Medcast

Peers & Perspectives

Conferences

Conference Listing

Conference Previews 

Conference Recaps

Publications

Urology Times Journal

Editorial Advisory Board

Urologists in Cancer Care

Supplements and Featured Publications

CME/CE

Resources

Begin Your Journey: Tackling Burnout

Live Events

Interactive Tools

Job Board

Partners

Subscribe

Urology Times is the leading resource for urologists & allied health professionals offering clinical analysis, policy perspectives, & practical advice.

About Us

Advertise

Editorial

Contact Us

Terms and Conditions

Privacy

Do not sell my Personnal Information

Urology Times | News & Insights for Urologists & Health Professionals

Facebook

LinkedIn

Spotlight

Peers and Perspectives

Clinical

1rem

Clinical Focus

Howard I. Scher, MD; Scott T. Tagawa, MD, MS, FACP; Mary-Ellen Taplin, MD

Medical Crossfire®: How Does Recent Evidence on PARP Inhibitors and Combinations Inform Treatment Planning for Prostate Cancer Now and In the Future?

Jason Hafron, MD; Aaron D. Berger, MD; Arpeet Shah, MD

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

® Assistant Editor Janelle Hart spoke with 

, about the presentation, “Feasibility and efficacy of transvaginal onabotulinumtoxinA chemodenervation of the trigone for the third line treatment of refractory overactive bladder,” which was given at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Winter Meeting. Dobberfuhl is a urologist at Stanford Hospitals and Clinics and an assistant professor of urology at the Stanford University School of Medicine in California.

“This technique is feasible, it is very well tolerated, and there’s not much of a complication rate, so it appears to be very safe,” says Amy D. Dobberfuhl, MD, MS.

Dr. Dobberfuhl discusses novel onabotulinumtoxinA treatment for refractory OAB

 She discusses the stigmas associated with overactive bladder, and how urologists can take the burden off of primary care physicians to educate patients who have this condition. Rogers is a urologist who specializes in incontinence at Sansum Clinic in Santa Barbara, California.

“We need to improve the fact that 75% of these patients are untreated [or] unmanaged and frustrated,” says Alexandra Rogers, MD.

Destigmatizing Urology: Dr. Alexandra Rogers discusses OAB

. He discusses urinary incontinence in male and female patients and how this condition can trigger major anxieties and avoidance behaviors. Seth is a consultant urological surgeon at St. George’s University hospital, London, UK.

“As health care professionals, we've got…an incredibly important role and responsibility with regards to increasing awareness and education, and then really trying to address the barriers and bring down the barriers,” says Jai Seth, MD.

Destigmatizing Urology: Dr. Seth discusses urinary incontinence

® Assistant Editor Janelle Hart spoke with J

. He discusses onabotulinumtoxinA injection programs as a treatment for urinary incontinence and the bleeding risk associated with these injections for patients who also take blood thinners. Seth is a consultant urological surgeon at St. George’s University hospital, London, UK.

“We're not saying a blanket stop for all patients, but I think we do need to be taking each patient as an individual in terms of their backgrounds,” says Jai Seth, MD.

Dr. Seth assesses the bleeding risk of Botox treatments in patients who take blood thinners

The UUI responder rate was 71.8% among those who received SNM and 71.3% among those who received iTNM.

iTNM may provide comparable safety, efficacy to SNM for OAB, UUI

The therapeutic response rate was 79% at 24 months, which is comparable to the rates seen at 6 months (78%) and 12 months (82%). 

OASIS: Efficacy of Revi System for urgency incontinence maintained at 2 years

At 1 month, the mean decrease in the OAB-Q symptom severity subscale score was -31.2 in the 1-injection cohort vs -39.5 in the 10-injection cohort. 

Comparable efficacy seen with single vs. multiple OnabotulinumtoxinA injection sites in OAB 

Over 12 weeks, the average reduction in total UI frequency was 2.3 episodes per day among those in the pelvic yoga program compared with 1.9 episodes per day among those in the general physical conditioning program.

Pelvic floor yoga is not superior to general physical conditioning for urinary incontinence

Data from a real-world evidence study of the Leva System were recently published in JMIR Formative Research, supporting the safety and effectiveness of the program in the treatment of patients with urinary incontinence.

New telehealth service provides access to Leva System for urinary incontinence

Andrew C. Peterson, MD, MPH, describes the study “The Artificial Urinary Sphincter Improves Depression, Anxiety and Overall Emotional Health in Men With Stress Urinary Incontinence; Analysis of the Artificial Urinary Sphincter Clinical Outcomes Trial (AUSCO)"

Expert details artificial urinary sphincter’s impact on depression and anxiety in men

 describes the study “The Artificial Urinary Sphincter Improves Depression, Anxiety and Overall Emotional Health in Men With Stress Urinary Incontinence; Analysis of the Artificial Urinary Sphincter Clinical Outcomes Trial (AUSCO),” which he presented at the 2024 Sexual Medicine Society of North America Fall Scientific Meeting in Scottsdale, Arizona. Peterson is a professor of surgery at Duke University in Durham, North Carolina.

To what extent do you believe the observed improvements in mental health can be attributed to the direct impact of the AUS on incontinence symptoms, or could other factors such as increased self-esteem or improved social functioning play a role?

I think they all go hand in hand. I think what we definitively have is a device that's been around for over 50 years now that now we know significantly improves quality of life with respect to self well-being, anxiety, anger scores, and depression scores, regardless of if there's confounding factors in there, the results are quite clear. The scores are pretty very bad prior to treatment, while men are leaking, and they go to better than normal, in most cases, after treatment. And these are men that had a number of pads on average that they use—around 4 to 5 pads per day, or 600 cc per day urinary loss preoperatively, and then postoperatively, the average number of pads went to around 1 pad per day. So while we had a significant improvement, not a complete cure of incontinence, we do have this really drastic improvement in these factors of quality of life, meaninganxiety, depression and self well-being.

The implications for the clinician are, I think that there's a very large component of depression, anxiety, and decision regret in these men who are continuing to leak after whatever treatment they've chosen for prostate cancer: radiation, surgery, a combination of those, and even men who have undergone surgeries for benign problems such as BPH. And I think, not to sound drastic or to sound too out of the box with this, but one could say we might even be saving lives with this. There probably is a component of potential self-harm that we're not recognizing in many of these men who are not seeking treatment or are not offered treatment. And then we we really help them out. Most of the principal investigators in this study, anecdotally, when we're discussing these results, do mention that they have had several men come back in their career and say, "I was really on my wit's end. I was very depressed, and I even thought about hurting myself, and this has changed all of that stuff." So it does sound sometimes a little drastic to make those type of statements, but I don't think we can over-read these results. We're significantly helping men with these anxiety, depression, and quality-of-life scores by treating incontinence, and I don't think we knew that before. This is really the first study that has helped us elaborate the components that we just mentioned.

This transcript was AI generated and edited by human editors for clarity.

Videos

The study presented by Dr. Andrew C. Peterson highlights the significant mental health benefits of the artificial urinary sphincter (AUS) in men with stress urinary incontinence. The AUS, a device with over 50 years of use, markedly improves quality of life by reducing anxiety, depression, and enhancing self-esteem. While not a complete cure, the reduction in urinary leakage from an average of 4-5 pads to 1 pad per day post-treatment is substantial. The study underscores the potential life-saving impact of addressing incontinence-related mental health issues.

"I think what we definitively have is a device that's been around for over 50 years now that now we know significantly improves quality of life," says Andrew C. Peterson, MD, MPH. 

Andrew C. Peterson, MD, MPH, describes the background and notable findings from the study “The Artificial Urinary Sphincter Improves Depression, Anxiety and Overall Emotional Health in Men With Stress Urinary Incontinence; Analysis of the Artificial Urinary Sphincter Clinical Outcomes Trial (AUSCO)"

Andrew C. Peterson, MD, MPH, on the QOL impact of the artificial urinary sphincter

 describes the background and notable findings from the study “The Artificial Urinary Sphincter Improves Depression, Anxiety and Overall Emotional Health in Men With Stress Urinary Incontinence; Analysis of the Artificial Urinary Sphincter Clinical Outcomes Trial (AUSCO),” which he presented at the 2024 Sexual Medicine Society of North America Fall Scientific Meeting in Scottsdale, Arizona. Peterson is a professor of surgery at Duke University in Durham, North Carolina.

Please describe the background for this study.

The AUSCO study, or the Artificial Urinary Sphincter Clinical Outcomes trial, was a multi-institutional, multinational study that was actually sponsored by Boston Scientific to look at the effects of the artificial urinary sphincter, or the AUS, on both clinical outcomes, which involved primary outcome being the cure or improvement of incontinence in men undergoing treatment with the device, and also secondary outcomes such as quality of life issues, as outlined with various types of questionnaires.

It involved 18 sites overall. I'm very honored to be able to present components of the preliminary data, because the study is still being wrapped up in conjunction with the AUSCO research team. The 3 primary principal investigators [included me as well as] Dr Hadley Wood at Cleveland Clinic [and] Dr Melissa Kaufman at Vanderbilt. But all of the other principal investigators are also primary components to the research project.

It was really put in place because of the company's requirements from the FDA, with their idea of potentially modifying the device in the future and bringing out different new types of devices that would also treat men for stress urinary incontinence. It's a prospective cohort where we enrolled men who were leaking after either treatment with prostate surgery for prostate cancer or TURPs or outlet procedures for BPH and lower urinary tract symptoms. Men had to leak. Before we enrolled every man, we documented how many pads they used per day, as well as the weight of the pads. We placed the device, and then we followed those men prospectively over time as a cohort, so they served as their own controls, meaning their baseline was the pretreatment and then postoperative follow-ups. We went out to 1 year with this cohort, and we evaluated them again with number of pads per day, and then patient outcome questionnaires to see their overall improvement.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

Anecdotally and clinically, many of us who treat men with post-prostate cancer treatment incontinence or incontinence primarily from other causes such as trauma or other types of surgeries, many of us have always talked about, these men, when we meet them, are pretty severely depressed and they're anxious. Many of them tell us stories about how they become homebound. They don't leave the house any longer because they have to wear diapers or multiple pads. They have a fear of travel because of significant fear of going through security at airports and getting wanded because they have a wet pad that gets seen on the X ray machine. And then many of them can't go out or go to other countries because they have fear of being able to obtain products to help keep them dry. So they, in a sense, become homebound. Spouses and partners have told us these types of stories as well. Again, when we place these devices, in the past, we've noticed, again, anecdotally, a significant improvement in this type of behavior where the spouse will come in or the partner and say, "Hey, he's a different person now. We go out all the time." And we also have all...had stories of men coming back and telling us that the [AUS] changed their life and really increased their attitude and their outlook on life. So we always thought there was a very, very large component of depression, anxiety, and even anger that accompanied decision regret, we would call it, with the idea that they got treated for prostate cancer and now they're leaking and their life is in shambles. So we decided to take a look at some of these components of the patient-reported outcomes that we accrued in this study. Many of those PROs included the I-QOL or Incontinence Quality of Life score, the IIQ-7, and the EQ-5D. All 3 of those questionnaires have components to them that include questions about anxiety and depression. We decided to take a look at how those components of these individual surveys changed from before treatment with the artificial urinary sphincter and after treatment with the artificial urinary sphincter.

We were really surprised that we found that the anxiety components in the depression questions in those 3 questionnaires really improved drastically when we compared them to pretreatment vs post treatment. In fact, 1 of the questions on the questionnaire for the I-QOL, is "I feel depressed because of my urinary incontinence." That significantly improved to "almost not at all," from "almost completely always" before surgery to after surgery. The IIQ-7 seven has a question that says, has urine leakage affected your emotional health? And again, that improved from "significant" to to "almost not at all" affecting their emotional health after surgery. And then the EQ-5D has a question about anxiety or depression that improved significantly. All of these went from very, very remarkable negative scores, meaning impact on quality life to very, very remarkably positive scores with very high statistical significance. We're talking P value is less than .0001, so unarguably a significant change in these types of components of quality of life for these men.

The AUSCO study, sponsored by Boston Scientific, evaluated the impact of the artificial urinary sphincter (AUS) on men with stress urinary incontinence, focusing on both clinical and quality of life outcomes. Conducted across 18 sites, the study involved men post-prostate surgery or with other urinary issues. Findings revealed significant improvements in depression, anxiety, and emotional health post-AUS implantation, as evidenced by patient-reported outcomes. The study highlighted the profound psychological benefits of AUS, with statistically significant improvements in quality of life scores.

"We were really surprised that we found that the anxiety components in the depression questions in those 3 questionnaires really improved drastically when we compared them to pretreatment vs post treatment," says Andrew C. Peterson, MD, MPH.

Cindy L. Amundsen, MD, shares updated 2-year data from the OASIS trial, which is evaluating the Revi System in patients with urgency urinary incontinence. 

Cindy Amundsen, MD, shares 2-year data on the Revi System for UUI

, shares updated 2-year data from the OASIS trial (NCT03596671), which is evaluating the Revi System in patients with urgency urinary incontinence (UUI). The findings were shared by Amundsen, who is a urogynecologist at Duke University in Durham, North Carolina, at Pelvic Floor Disorders Week 2024 in Washington, DC.

In total, 151 patients were initially enrolled in the trial, of whom 97 completed the 24-month assessment. Data showed that 79% of patients experienced a response to therapy, and 56% achieved at least a 75% reduction in UUI episodes. Regarding safety, no serious device- or procedure-related adverse events were observed at 24 months.

The great thing about this study is that although we looked at the outcomes at 6 months as a primary outcome for their first paper, we also then followed patients for 12 months, and I'll be presenting the 24-month outcomes. Again, all [patients who] were recruited were women who mainly suffer from urgency incontinence, though the devices is also FDA approved for men.

The outcomes were looking at safety. When you have a new device, especially placed in an area that urogynecologists and urologists are not operating in, which is the ankle, we want the device to be safe, and, of course, the therapy effective[ness]. I think that's the great thing that we found out by this device. The explantation rates were extremely low at 2%, and they were explanted not because of device or procedure-related [reasons]. Because this particular Revi System is anchored to the fascia, we did not see any migrations of this device in the ankle, and no long-term pain or any problems with patients able to return to their regular activities. So, that was all very good. All adverse events were mild and moderate and were around the time of implant, which is typical, [and requires a] need for maybe some antibiotics or anti-inflammatory medication. These side effects or adverse events were resolved.

And then, of course, the other thing we want to know about the device is its efficacy. The good thing about it is it rivals other neuromodulation devices that are already on the market. This is a more minimally invasive option for individuals, and the rates were sustained throughout the whole 2-year period of time. Over 80% of the patients are greater than 50% improved, and 50% [had] over [a] 75% reduction in UUI episodes. [These were] very exciting results that were sustainable, and also adverse events very low.

This transcription was AI generated and edited by human editors for clarity.

1. Amundsen C, Heesakkers J, Toozs-Hobson P, et al. 2 year results: Revi therapy, implanted neuromodulator for urgency incontinence. Presented at: Pelvic Floor Disorders Week 2024. October 22-25, 2024. Washington, DC

The OASIS trial evaluates the Revi System for urgency urinary incontinence (UUI), showing promising 2-year results. Of 151 enrolled patients, 97 completed the 24-month assessment, with 79% responding to therapy and 56% achieving at least a 75% reduction in UUI episodes. The Revi System demonstrated a strong safety profile, with no serious device- or procedure-related adverse events. The device, anchored to the fascia, showed low explantation rates and no migration issues. Efficacy was comparable to existing neuromodulation devices, offering a minimally invasive option.

“Over 80% of the patients are greater than 50% improved, and 50% [had] over [a] 75% reduction in UUI episodes,” says Cindy L. Amundsen, MD. 

Gamal M. Ghoniem, MD, FACS, ABU/FPMRS, discusses his current research efforts

Research focuses on identifying targets for overactive bladder treatment

 discusses his current research efforts. Ghoniem is Emeritus Professor of Urology at UCI School of Medicine.

What research projects are you currently working on?

I'm working on a very interesting project. It's an anatomy project, on female cadavers, trying to find, where are these nerves? If we want to do a targeted therapy, we have to know exactly where and what we are treating. So that's what I'm working on...I'm very excited about it because we used to study the bladder alone, and gynecologists studied the vagina going alone. But this is between the whole spectrum, between the vaginal wall and the bladder wall. So that's what I'm working on now, and defining where these targets [are] [for treating] overactive bladder.

This transcription was edited for clarity.

"If we want to do a targeted therapy, we have to know exactly where and what we are treating," says Gamal M. Ghoniem, MD, FACS, ABU/FPMRS.

discusses the potential impact of the new AUA/SUFU guideline on overactive bladder on his practice

Dr. Das on the impact of the new overactive bladder guideline on his practice

 discusses the potential impact of the new AUA/SUFU guideline on overactive bladder on his practice. Das is a UCI Health urologist and a professor of urology at UCI School of Medicine.

Will the new AUA/SUFU guideline on overactive bladder change how you practice?

It will. There are people who come in and they say, "I have to go to the bathroom 20 times a day. I can't make it to the bathroom because the urgency is so strong." Throwing some medications with these side effects...I think if you can get a Botox injection, and you get better, it's hard to argue with that [vs] being on months and months of medications that may not work. I think it really is going to change my practice.

"I think it really is going to change my practice," says Akhil Das, MD, FACS.

Dr Sebesta on “Household Toilet and Sanitation Insecurity is Associated with Urinary Symptoms, Psychosocial Burden, and Compensatory Bladder Behaviors.” 

Household toilet and sanitation insecurity’s implications for urinary symptoms and beyond

 discusses the wider implications of the findings from her 

study “Household Toilet and Sanitation Insecurity is Associated with Urinary Symptoms, Psychosocial Burden, and Compensatory Bladder Behaviors.” Sebesta is an assistant professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee.

Beyond the specific focus on urinary health, do you believe toilet and sanitation insecurity might have broader implications for public health? If so, in what areas?

Access to clean water and having reliable sewage systems is a huge public health issue. There are some public health implications we commonly think of when talking about clean water and sanitation access, like water-borne pathogens, water pollution, and infectious diseases due to exposure to unsanitary conditions. These things actually do still exist in the United States and other wealthy nations, for people who don't have access to clean water and functional sanitation. I think the COVID-19 pandemic obviously brought to light a lot of health disparities that exist in our country. In this context, for example, people who didn't have access to good running water in their home, can't wash their hands regularly, [so] they're at increased risk for COVID or spreading disease. It highlighted issues that people faced at home when they were forced to quarantine. Someone might rely on using a public or work or school bathroom several times a day [and are] now being forced to stay home and not have as good of access to other options. And so this is a huge public health problem. There are numerous reports throughout the COVID-19 pandemic of people having to come up with other solutions or landlords being unable to get plumbing fixed due to the pandemic. And so I think there's a huge, widespread public health issue that comes to light when you start compounding the limited access, like what happened during the pandemic. I specifically try to look at the effects on chronic health conditions like bladder health. You can imagine, although this isn't my area of expertise, the same might be true for the health and psychosocial impact for people with inflammatory bowel disease, or fecal incontinence. And so having a clean supply of reliable, safe place to urinate, are basic human rights. Everyone urinates, and so these things affect everyone to some degree. And so, when you look at the investment in the United States and other wealthy countries, on funding to help this issue, it's really lacking. There were a lot of federal resources allocated to water and sanitation in our country in the 1970s. And unfortunately, a lot of vulnerable populations didn't benefit from those initial investments. And then basically, the funding for sanitation has steadily declined since then. Our sanitation systems are aging, the population is growing. So there's a huge water access gap in the United States. That's really underappreciated. And the other side of this study is basically just understanding more about the people who are most impacted here. And so these are findings from other public health studies, in addition to my own, that race and ethnicity are some of the strongest predictors of plumbing poverty. It's been demonstrated time and time again, that Black, Latinx, American Indian households are disproportionately affected by these issues in major cities. Household income is a huge risk factor. People who are renters or basically people who don't own a single family home are huge risk factors. This became particularly of interest to me, because a lot of areas that surround Nashville, where I practice, the rural south, rural Appalachia, people have terrible issues with access to clean water, and issues with personal sewage systems in their home due to the soil type down here. And so these issues are really compounded by a lot of these other factors: racialized wealth gaps, housing sector problems, discriminatory infrastructure. And so my whole hope here is to draw attention to this and how it continues to be an active problem in our country. And if we can show that it has effects on long-term health outcomes, that's a good first step to draw some attention toward finding solutions. Urologists are certainly people in the medical community that are well suited to talk to people about this and to help give a voice to our patients that tell us that they're suffering from these problems.

"Access to clean water and having reliable sewage systems is a huge public health issue," says Elisabeth M. Sebesta, MD.

Zhina Sadeghi, MD, discusses her work on researching neurogenic bladder

Dr. Sadeghi on research into neurogenic bladder

 discusses her work on researching neurogenic bladder. Sadeghi is a UCI Health urologist and assistant professor of urology at UCI School of Medicine.

What do you feel is underreported or underappreciated in your field of expertise?

As I mentioned, I'm also a part of a national neurogenic bladder research group. We are a group of neurourologists across the United States. We have come together to be able to facilitate big multicenter clinical trials on patients with neurogenic bladder. That means bladders with spinal cord injury issues, multiple sclerosis, Parkinson's, any neurological issue that impacts the bladder, and we do have that in the society; a big proportion of our neurogenic patients have neurogenic bladder issues like retention; they leak urine, they have urgency, they may not be able to have a safe bladder for the kidneys to stay safe. So there are few trials right now we are running on patients with multiple sclerosis, both on neuromodulation of their bladder and also understanding the relationship between the level of their lesion in the central nervous system compared with bladder symptoms, and we are running those in collaboration with the University of Michigan. We also do have another interesting study we are running with Houston Methodist Hospital and we are working on finding a biomarker in the urine of patients with spinal cord injury that can help us predict if this patient would deteriorate fast with their bladder or are they going to be responsive to neuromodulation treatment? We are basically having a multi arm study going on with this. These are all very exciting for me. My goal as a "plumber" urologist is to see if we can find better options and also understand the mechanism behind the disease that are going around the urinary tract system; either it's a bladder or urethra.

"My goal as a 'plumber'/urologist is to see if we can find better options and also understand the mechanism behind the disease," says Zhina Sadeghi, MD.

Dr. Sebesta on future research on interventions for toilet and sanitation insecurity

 discusses potential mechanisms linking insecurity and both urinary symptoms and psychosocial factors. She is an author of the 

The study identifies a concerning link between insecurity and unhealthy compensatory bladder behaviors. Do you see potential for future research to explore interventions that could address both the insecurity and the negative coping mechanisms?

This is kind of the last part of this cycle that I'm talking about, connecting toilet and sanitation insecurity to urinary symptoms. We all have coping strategies that we use to deal with unpleasant emotions or situations. And in urology, there are certain toileting behaviors that people utilize to help cope with urinary symptoms or compensate for their disease state like overactive bladder. There are different types of coping, so there are primary strategies, which are focused on problem solving. In urology, this might be like planning an activity or restroom mapping. This is like what you would you would tell someone to do if you want to help them develop healthy bladder coping behaviors, but there are also disengaged strategies, which are more maladaptive. This results when you are managing a stressful situation with avoidance, so avoiding certain activities, avoiding socialization, staying home, that kind of stuff. We've found that people with toilet and sanitation insecurity are more likely to adopt any compensatory bladder behavior, but specifically some of those really maladaptive behaviors. And so this, like I said, is kind of the thing that helps connect this whole picture, like those people without reliable access to toilets and plumbing in their home have worse urinary symptoms, they have stress about this situation, anxiety about this situation. And then to cope with it, they develop maladaptive compensatory bladder behaviors, and this then becomes something that just continues to propagate forward. And so the lack of toilets just becomes the driver of this whole cycle. And so in terms of future knowledge about this, yes, absolutely. I think that coping is a key way that we can help intervene here, acutely if you're talking to someone or a patient who's experiencing some of these situations at home, teaching somebody primary control coping strategies over the avoiding maladaptive strategies is a great way to help them manage their stress and even manage their overall urinary symptoms. Enhancing coping strategies is a really practical thing that can be implemented in a clinical setting, and if coping continues to become a particular struggle for a patient, of course, they should be referred to someone with more specialization and coping like behavioral medicine to help. But yes, this is certainly something that would be interesting to consider for the future. Like, can you help toilet-insecure people manage their stress and anxiety and lower urinary tract symptoms by teaching them to improve their coping behaviors or on toileting?

"I think that coping is a key way that we can help intervene here," says Elisabeth M. Sebesta, MD.

Dr Zillioux on “Prevalence of Cognitive and Manual Dexterity Disorders Among Men Following Artificial Urinary Sphincter Placement.” 

Dr. Zillioux on assessing cognitive impairment and manual dexterity in patients undergoing AUS placement

study “Prevalence of Cognitive and Manual Dexterity Disorders Among Men Following Artificial Urinary Sphincter Placement.” Zillioux is an assistant professor of urology at the University of Virginia in Charlottesville.

What is the take-home message for the practicing urologist?

I think the take-home message is that cognitive impairment and manual dexterity issues are common in these patients, and we should not only be assessing for these at baseline but also ensuring that the patients have routine and longitudinal follow-up and that some sort of assessment is done at these follow up visits. It might be as simple as saying, "Show me how to cycle this device," which I think a lot of people are doing anyways. But it can also be doing a hand strength test or doing a timed get-up-and-go for frailty test. There are different cognitive screening tests. But the take-home is that we should be paying attention to these on follow-up.

Elisabeth M. Sebesta, MD, discusses potential mechanisms linking insecurity and both urinary symptoms and psychosocial factors

What mechanisms link toilet insecurity and urinary symptoms?

Your results highlight the association between insecurity and both urinary symptoms and psychosocial burden. Can you elaborate on the potential mechanisms linking these factors?

We talked a little bit about how I think that urinary symptoms might play into this. But basically as kind of mechanisms to understand the associations that I observed between being at risk for toilet and sanitation insecurity and worse urinary symptoms, we looked at both psychosocial burden and then some coping behaviors. And so in terms of the psychosocial aspect of things, people with toilet insecurity are more likely to experience greater stress and anxiety, report poorer social support, have a poor overall perception of their health, again, even after controlling for some confounders. And so this, I think, becomes like a moderator to link these 2 associations. We know that psychosocial burden can be experienced by people with worse urinary symptoms. This has been observed in many urologic conditions: overactive bladder, incontinence. And so if you have a lot of urinary frequency and you don't have good, reliable access to a toilet, it makes sense that this would like increase your overall stress and anxiety around this situation. And so my hypothesis is that the psychosocial burden experienced by people affected by this then becomes part of the mechanism that helps to drive the cycle forward and perpetuate it.

"In terms of the psychosocial aspect of things, people with toilet insecurity are more likely to experience greater stress and anxiety, report poorer social support, have a poor overall perception of their health, even after controlling for some confounders," says Elisabeth M. Sebesta, MD.

Panelists conclude their discussion by reflecting on key learnings and sharing advice for patient-centric management in overactive bladder (OAB) treatment.

Enhancing Patient-Centric Management in OAB in 2024 and Beyond

 So it seems like you both have really patient-centric management in regards to all the therapies, specifically for in -practice treatments, such as Botox therapy. Any advice you'd give to some of our colleagues listening here, what could they do? to enhance that patient experience that may be something simple? I know, Dr. Eilber, you actually mentioned you modified things recently, but I'll have each of you say what things could they do?

 I think the two things that people really fear are the catheterization, and that they will happen the middle of the night. So I think it's the same as when we're young. giving those post -procedure instructions, you say there is, and the patients get their first injection, of course, there is a risk of retention. It is very low. However, it doesn't happen instantaneously. We'll see you at two weeks. And if you're retaining a lot then, we can teach you how to empty your bladder. If you feel you're struggling more and more, call us, we'll see you sooner. But I can tell them in good conscience, I've never had anybody go into a cube retention. you know, within that timeframe because of that. And so I think that's really what people fear is that they're going to go into acute retention, no one's going to be around. And that's not really how it works.

 And Dr. Benson? Yeah, two things. The first, get it out of the operating room, if you can, and move it to your office.

 That'd be the single biggest thing. I can't tell you how many patients come to my practice that have been out. elsewhere and they say, you're not going to take me to the operating room and sedate me. And some of these have had, you know, eight, 10, 12, 20 injections and every time they're going to the operating room. So I first say, look at your practice model, try to take it out of the operating room. And then secondly is follow your data and follow your patient satisfaction data because if you're wondering whether it's working, it's really helpful. for you to somehow quantify that for yourself because it's a reinforcing tool to really help you to think about using it. Because there's very few things that we do with the exception of perhaps a sling that's so satisfying to patients, that's so reinforcing for not only you, but your staff. So we share these data with their staff, and we share kind of success data and stuff because it helps everybody on the team reinforce that central goal, which is we want effective care for patients. So really do take a methodologic way of looking at this and say, hey, how are we doing with this and strive to improve with it?

 Well, I think those are fantastic ideas and I'm sure they can be implemented. I just want to let you know this has been a fantastic discussion. It's been very interactive and lively your experts within your field. But before I conclude, I'd like to get some final thoughts from each of you. Really, what are you looking forward to in 2024, really to address the needs of the OAB landscape. And Dr. Benson, I'll start with you.

 For myself, it's the implantable tibial. You know, I think that that's going to be a game changer. It's going to open the landscape open to a lot more people. And I think that the other thing is perhaps looking at instead of a tiered therapy approach that whether it be through societies, through ourselves that we look at this to say, do we have to go through A to get to B to get to C? Or can we go through A to get to C? take a more-broad approach to offering more effective care sooner? So I hope that there will be a move of foot that we can ultimately change the ability to get patients care quicker and more efficiently.

 That was going to be my exact sentiment. Whether it happens in 2024 or whatever year, but I would love to get rid of some of these insurers that require patients fail. Multiple medications before moving on to other therapies. I think, yes, having the implantable tibial will be a game changer for a lot of people, but it is sometimes disappointing when you really want to offer something to a patient and they just cannot afford it. And you just watch them struggle. And these are people who would be fine, take medication. They're a little too scared to do something invasive and yet the only medication they can afford is the one that gives them corpus. A horrible side effect. So I do hope that the way our algorithm is in terms of approving the third line therapies changes soon.

Well, that's fantastic. Once again, I'd like to thank Dr. Kevin Benson. I'd like to thank Dr. Eilber, also to our viewing audience tonight. We hope that you found this few points discussion informative and hope that it'll benefit your practice.

*Video transcript is AI-generated and reviewed by Urology Times® editorial staff.

Panelists conclude their discussion by reflecting on key learnings and sharing advice for patient-centric management in overactive bladder (OAB) treatment, specifically focusing on effective communication and overlooked aspects of patient care. They offer guidance to other providers on enhancing patient experiences, particularly with procedures like Botox. The episode wraps up with each expert sharing their final thoughts and anticipations for advancements in OAB treatment in 2024, highlighting their commitment to addressing patient needs in this evolving field.

Viewpoints

Dr. Kennelly, Dr. Kevin Benson, and Dr. Karyn Eilber share their approaches to post-procedure care and follow-up for overactive bladder (OAB) treatments.

Optimizing Post-Procedure Care and Follow-Up in OAB Treatments

 Dr Eilber do you actually use after the procedure like a post procedure instruction sheet or how do you manage people afterwards? I'm probably a minimalist when it comes to afterwards.

 I mean, there's really not a reason to have to wait for people. to avoid. They all have OAB. The Botox doesn't work immediately. So, you know, there's no reason I think they're going to have any retention after the procedure. While I'm injecting, I am giving the post procedure instructions again to contribute to that verbal anesthesia. So I'll say, you know, remember, this doesn't work right away. You're going to be the same today, tomorrow and probably next week. You might have some pink urine. I think another thing to add. what we were talking about earlier is during the procedure, inviting the patients to look at the screen. The majority of people are fascinated and they will get very distracted. Some people look away, we've discussed immediately and that's okay too, but post procedure, there's not really a lot, there's no limitations. People can resume their regular activity, obviously except for the patients who get premedicated, maybe can't drive for a little bit, but for the most part, there's not really a lot. lot that needs to be done post procedure. I think it's just like with a regular cystoscopy, it's very unusual for people to have discomfort afterwards.

One of the most important things we reinforce is it's not going to be better overnight . And I can't stress that enough that it's a slow acting procedure and it's going to take time. We used to have patients who would call like day three, I'm not better. I'm not better. And so we always say it's two to four weeks, and you're going to see that improvement. Now, if we've done a first time Botox injection, we will see them back at that point to reassess efficacy to check a PVR and to make sure their urine's clear.So again, we go through some of that touch point during the procedure as well. Those that have done, you know, 12 of these, it's a different situation. But for those people new into the the procedure, we do really make sure that they feel like they're in the fold that they're going to get follow up after they've done this. And that it's going to be a gradual consistent improvement, you don't have to worry about waking up tomorrow and not being able to urinate because that's the other real concern they have when they leave is am I going to be in retention tomorrow? Because they've read that risk. We've tried to alleviate that put that into better, you know, terms and probabilities. But they are terrified. They're not going to be able to urinate. They're going to end up in the ER with a catheter. So I would really reinforce to go through that part of it with them and make sure they're comfortable.

 Yeah. I think you're, you both have mentioned that kind of the right out the procedure, the following up and early on fall for the first time, you know, botulinum toxin patient is great. And that may be at a one week to two week or three week touch point after that touch point to you. follow them beyond that? Or we know that at least in the clinical trials, the results lasted approximately six months. Is there a touch point between there or what have you found in your practices to keep people online?

I don't have a touch point after that, but when I see the first time inject or patients having their first injections at that two week mark, if it helped them, them and they're interested in continuing it, I go ahead and schedule them six months from them and tell them, you know, on average people last six months. If when you come for that one you tell me it really wore off it, you know, four and a half months and we'll schedule them every four and a half or five months moving forward. If you get to six months and you're really perfect, just postpone your appointment for a month and we'll figure out your duration of response, but it's like the OAB meds. Before telehealth, we just had this impression they would come back. I think it's good to make their six month appointment for two reasons. One is it's like the dentist. If you don't make it when you leave, you just forget. And despite what we tell people, there are a fair number of patients who still think it's supposed to last forever.

So they feel that the Botox didn't work because it wore off over a period of time. The other thing I think. is just from a practice efficiency perspective, you need to do that because if you're gonna be working with Botox a lot, you're gonna have limitations on equipment, you're gonna have limitations on spots. And the more predictable you can make that because we do have trouble where patients will call up and say, well, I would like to be in next week because it wore off and that's often just not attainable. So from just the practice efficiency and predictability perspective, it's important.

In this discussion, Dr. Kennelly, Dr. Kevin Benson, and Dr. Karyn Eilber share their approaches to post-procedure care and follow-up for overactive bladder (OAB) treatments. They detail the patient experience immediately after the procedure, the role of nursing and support staff, and methods for guiding patients through the recovery process, including managing potential complications and effective communication strategies. Additionally, they address challenges in patient adherence to follow-up visits, share insights on assessing treatment effectiveness during these visits, and discuss their strategies for enhancing patient engagement and satisfaction in their practices.

OAB and Incontinence

Latest News