Opinion
Video
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.
Transcript:
Dr Kennelly: 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.
Dr. Karyn Eilber: 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.
Dr. Kennelly: 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.
Dr. Benson: One thing that we have done is we automatically will make their six month appointment and we always go with six months just Dr. Eilber said we want to make sure that that's kind of the general standard but about a week or two before we have an automated system that will send them a text just to remind them and also that in that text we say if you have other issues you'd like to discuss please let usknow. Because what we do find is patients have a lot of things going on. And oftentimes those patients back just for Botox are not really just back for Botox. So it's allowed us to take better assessment of other issues they might have so those appointments can be efficient. And also if they have any concerns about continuing Botox, why not change their dose, et cetera, they can make us aware of that. So I think those are some key considerations.
Dr Kennelly: Yeah, and I think you bring up some good points there and it sounded like earlier you stated that the first time Botox injection people have a lot of concerns and so checking in with them right away to alleviate some of those concerns but after their concerns have been alleviated they've been through it once it seems like Dr. Eilber people are on you know if you're consistent there they're on autopilot but you know their fears are there they get close comfortable with your staff staff, their procedure, and things can be managed in an efficient way. They can and just automatically schedule them. The one thing I have observed over the years though is invariably when people are five, six, seven into their series of injections, they'll say, you know, none of my injections were ever as good as the first. And you have to remind them that's because we never let you get back to your baseline. but it is kind of interesting that people perceive that it didn't work as well later and they forget how bad they were before their first one and I say, well, we're trying to be kind to you and not make you go back to baseline preemptively treating you.
Dr. Kennelly: Right. And I think that's kind of the key I've noticed in my practice is once you get someone that's doing well, we want to maintain that. Don't let them sort of come back down.
Dr Benson: You know, the other thing that I found is patients very much know when Botox wears off for them and I always ask you know again trying to figure out how often we should have them back you know how do you think it's working they'll say you know what two weeks ago on Tuesday I quit working and I'm just I find it interesting that it's that black and white for them but they will almost always to a degree either A) it's working great or B) it wore off and then we try to tailor that based on what they've said. And I also let them know there is some variability between injections. Not every injection is going to be identical to the one previous. And, you know, one injection that may not work as effectively as this kind of a fluke, two might be a pattern. I don't necessarily change their injection paradigm if they have had one that's been a little off. But that's just another point for follow -up and staying connected with them to say, and staying connected with them to say, "Hey, if you had one that's been a little off, hasn't been as good, then we might bring them back in for another appointment before their next injection, just to make sure it's working well.
*Video transcript is AI-generated and reviewed by Urology Times® editorial staff.
