2025 AUGS Clinical Meeting-When Meds Just Aren’t Cutting It: Third Line Treatment Options for OAB

Video Transcription

Video Summary

The presentation discusses advanced treatment options for overactive bladder (OAB) when medications alone are insufficient. The speaker, who has significant professional involvement in the field, advocates for equal conflict in presenting unbiased options. Overactive bladder, characterized by urgency, frequency, and nocturia, can sometimes be linked to microbiome issues. In some cases, dysbiosis—a microbial imbalance—might play a role in OAB symptoms. The speaker has evolved to consider UTI prevention before OAB treatment in patients with recurrent UTIs and emphasizes the potential of vaginal estrogen therapy in reshaping the microbiome, especially during the menopausal transition.<br /><br />Advanced therapies beyond medications include Botox and neuromodulation. While Botox has proved effective in clinical trials, sacral neuromodulation, especially the newer implantable devices, offers a long-term solution. The talk highlights lifestyle factors and patient conditions, such as co-occurring bowel issues or neurologic conditions, that influence treatment choices. The discussion also brings attention to the importance of cognitive function risks associated with anticholinergics in older patients, suggesting an inclination towards avoiding these where possible.<br /><br />The speaker emphasizes personalized treatment approaches, informed by patient lifestyle preferences, clinical evidence, and the evolving landscape of OAB management technologies.

Asset Subtitle

An in depth look at chemodenervation of the bladder and the various neurostimulation options for refractory OAB patients.

Speaker - Nazema Y. Siddiqui, MD, MHSc

Keywords

overactive bladder

advanced treatment

microbiome

neuromodulation

vaginal estrogen

personalized treatment

anticholinergics