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Clinical Focus

Oncology Decoded Live! Revolutionizing GU Cancer Care: Applying Cutting-Edge Evidence to Practice

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

Functional success was achieved in 58% of patients at 5-year follow-up. 

ROBUST I: Optilume maintains durable efficacy, safety for urethral strictures

Sunobinop resulted in a reduction in urinary urgency, urinary frequency, and incontinence episodes over the treatment period compared with placebo.

Sunobinop shows promise in phase 1b trial for overactive bladder

The approval of vibegron is supported by data from the phase 3 COURAGE trial.

FDA approves vibegron for OAB symptoms in pharmacologically treated BPH 

"I think this is a very important trial, just to bring some importance about patients' worries about being sexually active with urinary incontinence," says LeRoy Jones, MD.

Sexual QOL improved at 12 months following AUS placement

The primary aims for the EVANESCE-II trial are to confirm the safety of the FemPulse System and to establish noninferiority to first-line tolterodine.

FDA greenlights pivotal trial of wearable bioelectronic device for OAB

Vanita Gaglani, RPT, gives an overview of her clinic and discusses the importance of seeing a pelvic floor physical therapist prior to undergoing radical prostatectomy

Physical therapist discusses her work in men undergoing prostatectomy

gives an overview of her clinic and discusses the importance of seeing a pelvic floor physical therapist prior to undergoing radical prostatectomy. Gaglani is a registered physical therapist and owner of Vanita’s Rehab in Melbourne, Florida. She was interviewed during the Desai Sethi Urology Institute Urology on the Beach meeting in Miami Beach, Florida.

Please provide an overview of your clinic.

Basically, my whole practice is focused on the pelvic floor, the bowel, and the bladder, but 99% is men who have had a radical prostatectomy. My main focus in my practice is to get them dry and back to their normal life without using pads or Depends or going to the bathroom. I use a multi-pronged approach. I focus on behavior modification, nutrition, hydration, and exercise. Exercise is not just Kegels; there are about 24 other exercises that all are required to make a man dry.

Why is it important to see a pelvic floor physical therapist prior to prostate surgery?

It is important to go to a therapist before surgery for several reasons. One is to know what causes bladder [aggravation], so that when you go for surgery, you are already prepared [so] that your bladder does not go into spasms, and you leak more. Second is what to eat, what to drink, what precautions to follow. The reasons the precautions are important is because [there are 5] cuts on the belly, and a person feels perfectly all right, but the pelvic floor is not healed, and it is a challenge for men not to go out and do activities like canoeing or yard work or golf, and then also having them do exercises in a correct manner. Kegels are great, but they are really geared toward women. And if men do similar Kegels, instead of getting dry, they'll start [having] more leakage. The reason being, [some] women have had children, and the pelvic floor is stretched out, and it needs to be hypertrophied and brought back in position, because the elasticity of the pelvic floor is lost. Men did not have children, so the pelvic floor needs to learn how to work with the bladder. It's a totally different concept. It is like a tendon transplant. When you move 1 tendon to another body, you have to first learn how to work it before you start pushing it or doing strenuous activity with it. So Kegels, in the end, will be more challenging, but initially they have to be started on a slow pace, and then slowly the endurance of the pelvic floor has to be picked up.

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

Videos

"I use a multi-pronged approach. I focus on behavior modification, nutrition, hydration, and exercise," says Vanita Gaglani, RPT.

Raveen Syan, MD, FPMRS, shares highlights from the session “Reconstructive Urology” at the at 2025 Desai Sethi Urology Institute Urology on the Beach meeting. 

Raveen Syan, MD, shares 2025 Urology on the Beach highlights

 shares highlights from the session “Reconstructive Urology” at the at 2025 Desai Sethi Urology Institute Urology on the Beach meeting. Syan is an assistant professor of clinical urology at Desai Sethi Urology Institute in Miami, Florida as well as course co-director for Urology on the Beach.

Please provide an overview of the sessions you moderated at 2025 Desai Sethi Urology Institute Urology on the Beach meeting.

One of the sessions I moderated was reconstructive urology. Now, that sounds like a funny term; it's because we wanted to collaborate with what we call genitourinary reconstructive surgery and female urology, or URPS. And part of the ambition of combining it is we have different perspectives for the same problems, and so it provides a unique perspective to hear from one another and learn from one another. During the session, we had Dr [Nick] Warner present the most fantastic videos on his innovations in endoscopic management of strictures, things I would never have even imagined. It was a fantastic lecture. From the female urology side, had Dr [J. Quentin] Clemens talking about advancements in understanding of interstitial cystitis. It's a very complex disease that's really under treated, and the work he's doing to try and provide better care and outcomes to these people who really suffer. Dr Anne Cameron discussed new innovations in neuromodulation, so talking about implantable tibial transcutaneous stimulation, all for the treatment of overactive bladder, and there's just amazing growth in that field. Every year, we're seeing more and more. I know this year we're going to see even more companies producing more products, more results, and hopefully really help change and improve patient outcomes, especially when it comes to overactive bladder.

"I know this year we're going to see even more companies producing more products, more results, and hopefully really help change and improve patient outcomes, especially when it comes to overactive bladder," says Raveen Syan, MD, FPMRS.

Jaspreet S. Sandhu, MD, summarizes his talk from the Desai Sethi Urology Institute Urology on the Beach meeting titled “Updates in Management of Male SUI” 

Jaspreet S. Sandhu, MD, on post-prostatectomy incontinence

summarizes his talk from the Desai Sethi Urology Institute Urology on the Beach meeting titled “Updates in Management of Male SUI” and discusses the psychological impact of urinary incontinence in men who have undergone radical prostatectomy. Sandhu is an attending surgeon at Memorial Sloan Kettering Cancer Center in New York, New York.

Please share some highlights from your Desai Sethi Urology Institute Urology on the Beach talk "Updates in Management of Male SUI."

I was asked to give a talk on updates and management of male stress urinary incontinence, which I did, and luckily, the AUA helped me out, because they had an amendment to our recent guideline on incontinence after prostate treatment. So it was basically going over evaluation, management, primarily focusing on new things, and pretty straightforward actually, because all the guidelines are available at auanet.org So anybody who wants to find out what I did can go there and just pretty much download everything.

How do you address the psychological impact of post-prostatectomy incontinence on patients, such as anxiety, depression, and social isolation?

That's a very good question. We actually don't have formal mental health folks that help us, unlike sexual medicine, where they do have formal psychiatrists and psychologists that work with them. But men, it has been shown over and over again that urinary incontinence is associated with depression, not exercising—patients actually have weight gain. They're isolated. That's actually very well documented. When I have patients come in, they've gained 10 to 20 pounds because they haven't been to gym recently. Part of the reason they haven't been the gym recently is because they leak a lot. You can help them and tell them, "If we can get your leakage or urinary incontinence better, there's a pretty good chance you'll get your life back." And in fact, once we do procedures—and by procedures I mean generally minor surgical procedures: slings, sphincters, balloons are the 3 that we talked about this morning—when they have those procedures, most of the patients afterwards think their life has changed. In fact, I have letters from patients saying, "you actually renewed my faith in the medical system because you helped me out so much." So if you can do this surgery well, patients actually go back to living a normal life, and they're immensely, immensely happy.

"If you can do this surgery well, patients actually go back to living a normal life, and they're immensely, immensely happy," says Jaspreet S. Sandhu, MD.

Anne Pelletier Cameron, MD, FRCSC, FPMRS, provides a summary of a talk she gave at the 2025 Desai Sethi Urology Institute Urology on the Beach meeting titled “Updated Neuromodulation Techniques: What Are the Optimal Results?” 

Anne Pelletier Cameron, MD, on neuromodulation options for OAB

Anne Pelletier Cameron, MD, FRCSC, FPMRS,

 provides a summary of a talk she gave at the 2025 Desai Sethi Urology Institute Urology on the Beach meeting titled “Updated Neuromodulation Techniques: What Are the Optimal Results?” Cameron is the James Montie Legacy Professor of Urology at the University of Michigan and Associate Chair of Quality and Safety and Service Chief for the Department of Urology, and director of the Clinical Urology Research Endeavor.

Neuromodulation has really taken off in the OAB space and in the urology world. Right now, there is so much research going on on what is the optimal nerve to stimulate and how best to stimulate that nerve. You can stimulate that nerve percutaneously; that is, with a needle through the skin. Or, there are implantable devices that can be implanted on the nerve, or sub fascially, really close to the nerve. People are also using battery devices, so devices that keep a charge and need to be replaced, but there are also devices that don't have a battery and require an external stimulator. So we have all of those variations now existing for both sacral neuromodulation and tibial neuromodulation. And also, there is new technology emerging for skin stimulation of the perineum that is just recently evolving to help control OAB symptoms.

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

"There is new technology emerging for skin stimulation of the perineum that is just recently evolving to help control OAB symptoms," says Anne Pelletier Cameron, MD, FRCSC, FPMRS.

Andrew C. Peterson, MD, MPH, discusses implications 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 counseling men regarding the artificial urinary sphincter

 discusses implications 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.

How can these findings be translated into clinical practice to optimize patient care and improve outcomes for men with SUI?

I think the component we as surgeons have always concentrated on is these very objective physical exam findings to relate to quality of life and to relate success of any device or surgery. For instance, any abstract or paper has to have number of pads and pad weight change in order to tell you that a device is working well for treatment of incontinence. I think that now we have good data that patient-reported outcomes have to be considered in these patient populations. We now have data that the PROs indicate significant anxiety and effects on quality of life, and the men being able to live their life normally and unencumbered and do things they want to do on a daily basis, and we've seen significant improvement with that with this study, and it's just an observational study. We've probably always seen that. The problem is, as surgeons, I don't think we've recognized that component and given it its due attention, and today is the day that I think we need to start doing this; in other words, start paying attention to how we're affecting their anxiety, their depression, their relationships with those around them, and how we're really improving those. Even though we're not going to 0 pads per day, most men are still wearing some, these other components, I think, outweigh the idea that we're not completely treating the incontinence. So an improvement, whatever it is, is really helping these men out, and I think we have to recognize that.

We use it currently in our counseling as well. Now, when I tell this story to men that we're meeting for the first time, maybe 6 months out from their surgery or radiation, or even 5 or 10 or 20 years out from their surgery or radiation, some of them look at it and say, "This is a mechanical thing. It's another surgery. I'm really not interested in surgery." When we tell them about the anxiety and the depression components, typically, we'll see the light go on in their head. Oftentimes, we'll see their family member, partner or spouse light up, as we say these types of things, and I think it can very much help them understand the other benefits they may get from undergoing treatment for male incontinence, such as the quality of life that we've been mentioning.

The study highlights the importance of considering patient-reported outcomes (PROs) in managing stress urinary incontinence (SUI) in men. While traditional metrics focus on physical improvements, the study emphasizes the significant impact of the artificial urinary sphincter on emotional health, including reductions in anxiety and depression. Surgeons are encouraged to integrate these findings into clinical practice, recognizing the broader benefits of treatment beyond physical symptoms. This approach can enhance patient counseling and decision-making, ultimately improving quality of life for men with SUI.

"I think that now we have good data that patient-reported outcomes have to be considered in these patient populations," says Andrew C. Peterson, MD, MPH. 

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.

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.

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.

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

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

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