July 16, 2018

Advanced Therapeutics for Overactive Bladder…third line therapy for men and women of all ages

By Jennifer Miles-Thomas, MD and Jessica DeLong, MD


The American Urological Association estimates that about 33 million Americans suffer from overactive bladder (OAB) – 30 percent of all men and 40 percent of women.  It’s one of the vexing conditions associated with aging, but OAB is prevalent in the general population as well.  A significant amount of OAB is never diagnosed or treated because many patients are embarrassed to reveal their symptoms to their family physician.

Symptoms of an overactive bladder can be caused by any number of conditions, including neurological disorders, diabetes, urinary tract infections, certain foods or drinks, or tumors.  In men, OAB can be caused by an enlarged prostate. No matter the etiology of the condition, OAB can have a tremendous negative impact on quality of life.

In the past, large surgeries like augmentation cystoplasty were performed to increase the capacity of the bladder when patients failed conventional treatments such as anticholinergic medications.  Today, however, advances in third line therapies are providing relief for patients of all ages, and those surgeries are less frequently performed.

OnabotulinumtoxinA (Botox) – The same substance that is used by cosmetic and plastic surgeons to smooth facial lines and wrinkles is injected directly into the bladder muscle, where it calms the nerves, helping block the signals that trigger overactive bladder.  Once relaxed, the bladder can hold more urine and is less overactive, eliminating the need for multiple trips to the bathroom.  Each Botox treatment lasts on average six months.

Percutaneous (or posterior) tibial nerve stimulation (PTNS) – Understood by patients as similar to acupuncture, PTNS is the least invasive form of neurostimulation.  The procedure targets the sacral plexus, which regulates bladder function, through an electrical pulse delivered via the tibial nerve.  The low electrical current calms down the bladder and allows it to retain more urine.  Initial PTNS generally consists of 12 quick, weekly treatments.  Patients then require less frequent maintenance treatments to maintain efficacy.

InterStim – After an in-office test of a temporary system to determine efficacy, this treatment involves the implantation of a neurostimulator next to the sacral nerves just above the tail bone.  The patient can adjust the stimulator as needed with a remote, applying personal programs, and can control the level of the stimulation by holding the programmer over the neurostimulator.

Studies have shown that these therapies are greater than 80 percent effective, and are offering new hope to patients with the sequelae of overactive bladder.  As the technology continues to improve, patients who were afraid to leave the proximity of their home bathrooms are increasingly able to enjoy a more normal lifestyle.

Jessica DeLong, MD

Jennifer Miles-Thomas, MD

Jessica DeLong, MD and Jennifer Miles-Thomas, MD are co-directors of the Center for Health and Wellness at Urology of Virginia.  www.urologyofva.net