SCOTTSDALE, AZ USA (UroToday.com) - Prior to their prepared talks, Dr. David Staskin queried the panelists regarding whether they had encountered any circumstances where they would strongly advocate for or recommend against a given treatment modality.
Dr.Kenneth Peters advocated for neuromodulation in patients who had both urinary and fecal incontinence. Dr. J. Quentin Clemens recommends against PTNS in patients who live far away or are otherwise restricted in their ability to get to the office for treatment, on a weekly basis, for 12 weeks. Dr. Clemens felt that patients who failed OnabotulinumtoxinA (BOTOX®) previously did poorly with SNM. At his institution they only have a 20% response rate in this subgroup. The panelists were unable to agree upon which treatment modality was the most cost-effective.
Dr. Peters discussed percutaneous tibial nerve stimulation (PTNS). He is currently working with a company developing an implanted lead that would allow for at home, patient-initiated PTNS. To date, two patients with neurogenic bladders have been implanted. Studies are underway to expand the indications for PTNS to chronic pelvic pain and fecal incontinence.
Dr. Clemens discussed sacral neuromodulation (SNM). He reviewed the theories of the mechanisms of action for SNM. It is believed that SNM augments inhibitory somatic afferents that are deficient in patients with OAB. He expressed the importance of having someone in the office who is facile in reprogramming the device as patients often require frequent reprogramming, which can significantly affect the success of the device.
Dr. Emily Cole discussed OnabotulinumtoxinA (BOTOX®). She reviewed phase 3 data supporting the continued efficacy of BOTOX® injection for urge incontinence, micturition episodes, and urgency after five injections. The trial also demonstrated a consistent duration of efficacy after multiple injections, which were timed based upon patient request.
Moderated by David R. Staskin, MD at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA
Panelists:
PTNS: Kenneth M. Peters, MD
SNM: J. Quentin Clemens, MD
OnabotulinumtoxinA: Emily E. Cole, MD
Reported for UroToday by Drew Freilich, MD. Dr. Freilich is a graduate of the University of Massachusetts Medical School and completed his urology residency at New York Medical College/Westchester Medical Center. He is currently a fellow in Female Urology, Neurourology and Reconstructive Urology at Medical University of South Carolina. He has authored more than 40 peer-reviewed articles, monographs, abstracts, and book chapters and abstracts. Dr. Freilich is a member of the American Urological Association and the Society for Urodynamics and Female Urology.