OAB CARE PATHWAY Alexandra Rogers MD www bladderboutique

OAB CARE PATHWAY Alexandra Rogers MD www. bladderboutique. com Initial Office Evaluation for OAB • Overactive bladder (OAB) • Stress Urinary Incontinence (SUI): • Strong urge to go to the bathroom • Leakage with sudden bladder pressure (i. e. • Frequent bathroom trips (>10/day) cough, sneeze, brisk movement, exercise & • Nocturia (waking up at night to pee) heavy lifting) • Urge incontinence (leakage with urge/without warning) If SUI symptoms are more bothersome these should be managed first with the SUI Clinical Care Pathway Conservative Treatments • Fluid & Irritant Reduction, Timed Voiding, Physical Therapy • Beta Agonist for 4 Weeks • Rare Side Effects: HTN, Headaches • Anticholinergic for 2 weeks • Common Side Effects: Dry Mouth, Dry Eyes, Constipation & CNS risk • TENS Unit for 1 week twice a day for 30 minutes: • No Side Effects Re-Evaluation in the Office • Assess Experience and change in Bladder Symptoms and decide on therapy plan *e. Coin Tibial Implant: NOT APPROVED FOR SALE (IDE Study Oct 2018 - Apr 2020) • 20 minute procedure to implant a nickel sized ~1. 3 cc device @ankle • Automatically stimulates the tibial nerve for bladder control twice weekly • Device exchanged after an average of 3 years of therapy using local anesthesia Urgent PC Therapy Clinic Electrical Needle Treatments • Must fail 2 OAB meds • 12 Weekly office visits @ankle • 30 Minute Stim Sessions Maintenance Treatments • 30 minute sessions monthly • Time Consuming Sacral Neuromodulation Outpatient Surgical Implant Phase 1 Testing: Sacral nerve stimulation with 7 day PNE wire procedure or 2 week Surgical lead @lower back Phase 2 Surgical Implant: • Placement of lead& battery with prior wire test or just battery if prior surgical lead placement Medtronic Device (Therapy since 1997) • ~15 cc battery placed @buttock • Battery lasts about 4 to 7 years (2006) • Outpatient Surgical battery exchange • No MRIs below the neck (*Pending Full Body Device) • Device receiver & smartphone remote management with 7 programs (2018) ~Poor usability per FDA Maude Database Botox Injection Clinic Procedure • Cystoscopic needle injections @bladder • Low risk of retention & UTI • Possible discomfort with Injections Repeat Procedures • Reinjection every 6 to 11 months Axonics Device (FDA Approval in 2019) • ~5 cc battery placed @buttock • Battery lasts about 15 years • Monthly ~1 Hour recharge with belt • Outpatient Surgical battery exchange • Full body MRI conditional • Simple Key Fob MRI Smart remote with 1 program • *Non-recharge Primary cell device pending