2025 Urogynecology for the Advanced Practice Provider-Overactive Bladder Refractory to Behavioral and Pharmacologic Management: Advanced Treatment Options

Video Transcription

Video Summary

Dr. Michael Gray, a nurse practitioner and professor in Urology and Nursing at the University of Virginia, discusses the complexities of managing nocturia and overactive bladder (OAB), recognizing them as distinct yet overlapping chronic conditions. He emphasizes the significance of understanding urinary urgency and introduces the issue of nocturia as not merely a symptom but a condition requiring specific attention. Dr. Gray outlines various treatment modalities and guidelines, advocating for integrating behavioral with pharmacological therapies. He explores advanced therapies such as intradetrusor Botox, percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation, emphasizing their efficacy and patient adherence challenges. PTNS is highlighted as a non-invasive and manageable therapy, particularly suitable for hands-on patient counseling, while Botox is touted for its comparative effectiveness against more invasive procedures. Dr. Gray also touches on the impracticality of the current therapeutic holiday mandates dictated by insurance providers, advocating for continual management of the chronic nature of OAB. Audience questions prompt further discussion on specific methodology, implications of diuretic timing, and potential adverse effects, affirming the critical need for personalized and pragmatic clinical approaches.

Asset Subtitle

Overactive bladder is increasingly recognized as a chronic symptom syndrome requiring a multidimensional approach based on shared decision making between provider and patient. This presentation will review treatment options for women who are refractory to behavrional and pharmacologic interventions. Specific interventions will include neuromodulation (percutaneous, transcutaneous, implanted tibial nerve stimulation, sacral neuromodulation), botilinum toxin injections) and several promising investigational intereventions.

Objectives:

Describe the evaluation and management options for women with OAB who are refractory to behavioral and pharmacologic interventions.
Discuss neuromodulatory interventiosn for women with refractory OAB.
Review principles of OAB management using intradetrusor botulinum toxin.

Speaker - Mikel Gray, PhD, FNP, PNP, CUNP, CCCN-AP, FAANP, FAAN

Keywords

nocturia

overactive bladder

urinary urgency

intravesical Botox

percutaneous tibial nerve stimulation

sacral neuromodulation

behavioral therapies