Overactive Bladder

• Manage medical issues such as diabetes, hypertension, poor mobility, and obesity

• Reduce fluid intake (i.e., consume under 64 ounces)

• Avoid bladder irritants (i.e., citrus, artificial sweeteners, carbonation, alcohol, caffeine, and spicy foods)

• Perform timed voiding and urinate before activities where bathroom access will be limited (i.e., shopping, meetings, driving, and flying)

• Working with a specialized therapist will maximize this option.

• This option might help improve Overactive Bladder symptoms and has no side effects.

Typically, medications, regardless of class, are not a successful long-term management strategy for OAB due to poor compliance, side effects, high cost, and/or ineffectiveness. Medication samples are great to try when available to see if OAB symptoms improve while using the drug. In some patients, medications might be a reasonable option when affordable and efficacious if tolerated. Most patients will be candidates for OAB therapies beyond medications.

Anti-cholinergic Drawbacks:

• 80% quit by year 1

• Commonly cause dry mouth, dry eyes, constipation and affect the central nervous system (i.e., linked to dementia)

• These still remain the predominant class of OAB medication prescribed due to lower price

Beta Agonist Drawbacks:

• 60% quit by 1 year

• Mybetriq sometimes causes headaches and increased blood pressure

• Usually costly and often require a prior authorization

• Only two non-generic options exist: Myrbetriq and Gemtesa

Peripheral Tibial Nerve Stimulation or Modulation (PTNS or PTNM) is an FDA-approved form of tibial nerve stimulation using a needle for patients with urinary urgency, frequency, and urge incontinence. The tibial nerve near your ankle is stimulated once a week for 12 weeks in the office and monthly thereafter if effective.

A small acupuncture needle is placed at the tibial nerve, and gentle electrical stimulation is applied for 30 minutes in the office.

The stimulation of the tibial nerve travels up the leg and connects with the nerves of the bladder to provide therapy.

• Study patients experienced a 70% reduction in Urge Urinary Incontinence after 12 weeks& a 90% reduction in reporting severe or very severe problems with their OAB.

• It often takes 6 weeks for an effect to be noticeable. After 12 weeks of treatment, maintenance therapy is needed monthly to maintain the effect.

• Patients must be able to make frequent office visits because treatment effects decline once treatment stops.

Botox is injected into the wall of the bladder to treat patients with overactive bladder symptoms.

This procedure is performed using cystoscopy and is often done in the clinic.

• 5 to 10 injections are delivered after the bladder has been treated with lidocaine to reduce discomfort.

• Blood thinners do not need to be held before the procedure.

• Antibiotics are not routinely given unless a symptomatic UTI occurs after the procedure (<5% at the Bladder Boutique).

• Relief typically occurs at 1 week.

• The effects of Botox are not permanent and generally last 6 months.

• Repeat injections are needed to maintain symptom improvement.

• In clinical trials, approximately 80% of patients had at least a 50% improvement in their symptoms, and about 20% were dry.

• Risks include, but are not limited to, bleeding, infection, urinary retention requiring catheterization (<1% at the Bladder Boutique), and lack of efficacy. Generally, symptoms are temporary.

• Patients considering Botox treatment should be willing to accept the possibility of performing self-catheterization or needing a bladder catheter for 40 days on average if retention occurs (<1% at the Bladder Boutique).

The eCoin tibial stimulator is FDA approved to treat urge urinary incontinence (UUI). The eCoin is a coin-sized, pacemaker-like device placed at the lower leg to stimulate the tibial nerve. The stimulation is delivered twice a week for 30 minutes automatically once activated. The therapy requires no device management with a remote and/or recharging. The eCoin is placed with just local anesthetic.

• 68% of patients experience at least a 50% improvement in urge urinary incontinence episodes.

• 81% are better and 39% are very much better.

• 89% would recommend eCoin to friends and family.

• There is a low risk of infection, discomfort, poor wound healing and need for explant after the eCoin procedure.

• The device is MRI conditional and lower extremity MRIs are contraindicated.

Sacral neuromodulation Implant Surgery (i.e., Axonics or Interstim) is a therapy for patients with urinary urgency, frequency, urge incontinence, urinary retention, fecal incontinence, fecal urgency, or bladder pain. The therapy is initially delivered with a testing procedure placed at an outpatient surgery center. A subsequent outpatient procedure follows to place the final implant.

To determine whether this therapy works for your symptoms, the process to a full implant occurs in phases. The first phase is a trial to see if your symptoms improve. This can be done with a testing procedure with temporary wires. This occurs in the outpatient setting.

In the first testing phase, we insert a thin wire near a sacral nerve at the lower back. We connect it to a pacemaker outside your body which stimulates the nerves to function better. The test period is usually 5-7 days. Voiding diaries are collected before and during the testing period to confirm the objective improvement of at least 50%.

During the trial period, we test to see if the stimulation controls your symptoms. The signals may have to be adjusted during this testing period. If it works in improving your symptoms, then we proceed to the next phase of the permanent implant.

If you are a therapy responder, a subsequent procedure is performed to place an implant. After the temporary test, a permanent wire is placed along with a battery. There is a patient-managed remote so that you can adjust the stimulation to ensure comfort, change between programs and turn off the device if needed.

Please see the OAB brochure for more details on SNM. After placement, the device is adjusted over time to maintain efficacy. Batteries are surgically replaced when needed.

• This procedure has been approved by the FDA since 1997. Approximately 88% of patients have over a 50% improvement in their symptoms at 24 months.

• At the Bladder Boutique 68% of patients are better, 16% much better and 5% very much better after final surgical implant.

• 63% are satisfied and 24% very satisfied after the 2 phase process.

• Risks include infection of the device requiring removal, pain at the lead site/ battery site, lead migration, electric shock, need for surgical revision (<1% at the Bladder Boutique for all of the above), and lack of efficacy (<10% at the Bladder Boutique for permanent leads placed by Dr Rogers). If a sub optimal event occurs, the device can be turned off, a procedure can be performed to correct the problem, or the device can be removed.

• SNM devices allow for an MRI of the entire body. Other imaging tests, such as CT scans and X-rays, can be performed.