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Overactive Bladder Syndrome

Overactive Bladder Syndrome (OAB) is a condition of urinary urgency, usually accompanied by frequency and night time voiding, with or without urgency related urinary incontinence. It is estimated that about 30% of men and 40% of women in the United States live with these symptoms. Often patients are not aware of the many treatment options that are available for them and therefore do not seek help. 

OAB is not simply a part of getting older and may be a sequelae of other underlying disease such as cancer or a primary dysfunction of the bladder. A thorough evaluation by an experienced urologist may lead to identification of the problem and possible cure. Quality of life can be severely and negatively affected by OAB, and finding a solution could be as simple as a visit to the urologist office. 

Many people have heard of a quivering heart or atrial fibrillation. Just as the heart is a muscle, so is the bladder. OAB to the bladder is what atrial fibrillation is to the heart. And just as we are able to treat A. Fib with medication or electrical stimulation, we are also able to treat OAB with the same types of techniques. 

We have developed a care pathway that allows patients to understand their disease process and options that are available. This pathway consists of three phases as shown in this diagram: 

Initial Evaluation

Phase 1

Conservative management:

  1. Bladder Training

  2. Pelvic Floor Muscle Training

  3. Fluid Management

  4. Bladder Control Strategies

Phase 2

Medication

2-4 weeks

Re-Evaluation

Phase 3

Botox®

(lasts 6-9 months)

PTNS
(Variable short duration)

Sacral Neuromodulation
(may last up to 20 years)

Sacral Neuromodulation
 

Sacral neuromodulation has been used for many years in patients with refractory OAB, Fecal Incontinence, and non-obstructive urinary retention. An office test can be performed to determine if a patient will benefit from this device called a peripheral nerve evaluation or PNE. If patient does qualify for this treatment, then a small battery is placed under the skin that may last as long as 5-10 years and control symptoms accordingly. Once the battery runs out, a new one can simply be placed. Studies have shown that 85% of people using SNM achieved success in the first year. There is also 3 times greater improvement in quality of life compared to medication. Dr. Shakuri-Rad is an expert in SNM and uses both Axonics and the InterStim therapy and is the first and only physician who has published a randomized controlled trial on the use of ultrasound for the placement of this device. He has also invented and developed devices in this space and is a world leader in SNM. 

 

Onabotulinum Toxin A
 

Botox® is a injectable paralytic toxin often used for cosmetic purposes to reduce wrinkles. Injection of this substance in the bladder may reduce the sensations of urgency and urgency associated urinary incontinence. The effects may wear off after a few weeks to months and repeat injections are necessary. Some patients may experience temporary urinary retention requiring self-catheterization. The injections are often done under anesthesia. Dr Shakuri-Rad performs this procedure for patients who are not interested in the SNM procedure or have failed other therapies. 

Peripheral Tibial Nerve Stimulation
 

Peripheral Tibial Nerve Stimulation or PTNS is a office procedure that may allow for fewer trips to the bathroom but requires once a week visit to the urologist office for 12 weeks. The effects of this treatment may not last long and often require repeated re-treatments. 

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