Developing and Implementing an OAB Practice Algorithm-Developing and Implementing an OAB Practice Algorithm

Video Transcription

Video Summary

This talk reviewed third-line therapies for non-neurogenic overactive bladder after behavioral and medication options. The three main treatments are intradetrusor onabotulinum toxin A (Botox), percutaneous tibial nerve stimulation (PTNS), and sacral neuromodulation (SNM). Botox is an office cystoscopic injection that improves symptoms in about two-thirds of patients, but carries risks of UTI, hematuria, and urinary retention, so patients must be willing to catheterize if needed. PTNS is the least invasive option, involving 12 weekly sessions and maintenance therapy; it has low risk but is time-intensive and may be less effective. SNM is an implanted, programmable device with durable benefit, reversible treatment, and added value for fecal incontinence or urinary retention, but it requires surgery, follow-up, and possible revisions or battery changes. Shared decision-making is emphasized because each therapy has different risks, benefits, and practical considerations.

Asset Caption

This was recorded as part of the Urogynecology for the Advanced Practice Provider in Nashville, TN on June 13-15, 2021. The speaker, Brian Linder, MD, MS, completed his Urology residency and then a Female Pelvic Medicine and Reconstructive Surgery Fellowship at Mayo Clinic. He provides care for women with pelvic floor disorders and is jointly appointed in the Department of Urology and the Department of Obstetrics and Gynecology at Mayo Clinic in Rochester, MN. In addition to his clinical practice, Dr. Linder is active in research and education, training residents and fellows. He is an Assistant Professor in both the Department of Urology and the Department of Obstetrics and Gynecology, having authored over 90 peer review publications, book chapters, etc. For his research on pelvic organ prolapse and urinary incontinence he has received grants and other awards.

Keywords

overactive bladder

third-line therapy

onabotulinum toxin A

percutaneous tibial nerve stimulation

sacral neuromodulation

shared decision-making