SUFU WM 2019

SUFU WM 2019

SUFU 2019: Outcomes of Midurethral Slings in the Obese Woman

Miami, FL (UroToday.com) The prevalence of obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, has increased in women 60 years of age and older from 31.5% in 2003-2004 to 38% in 2011-2012. The Centers for Disease Control (CDC) further stratifies obesity into three classes: Class I (BMI 30-35), Class II (BMI 35-40), and Class III (BMI>40).

Obesity has been shown in multiple studies to be a risk factor for stress urinary incontinence (SUI), and it remains a viable option in these patients who seek treatment for SUI. 

SUFU 2019: Three-Year Followup Results of a Prospective, Multicenter Study with a Wireless Implantable Tibial Nerve Stimulator (RENOVA iStim™ System) in Patients with Overactive Bladder

Miami, FL (UroToday.com) Overactive bladder (OAB) is a highly prevalent condition that can be challenging to treat in patients for whom medical management fails. For those who fail first- or second-line treatment options, neuromodulation offers an alternative treatment option, either in the form of percutaneous tibial nerve stimulation or sacral neuromodulation.

SUFU 2019: Numerous Socioeconomic and Ethnic Factors Predict Receiving Advanced OAB Therapies in a Commercially Insured Population

Miami, FL (UroToday.com) Studies suggest ethnic and socioeconomic disparities exist among patients with overactive bladder (OAB). Prior studies have found that OAB symptoms occur at higher rates in blacks and Hispanics and at lower rates in Asians. Furthermore, patients with lower incomes and educational backgrounds have been found to be less likely to discuss urinary incontinence. Minority Medicare populations have also been shown to be less likely to undergo sacral neuromodulation therapy (SNS) than white patients.

SUFU 2019: Prophylactic Midurethral Slings at the Time of Pelvic Organ Prolapse Repair Surgery to Prevent De-Novo Stress Urinary Incontinence - A Need to Reappraise?

Miami, FL (UroToday.com) Prophylactic sling placement may prevent de-novo stress urinary incontinence (SUI) in women undergoing pelvic organ prolapse (POP) surgery. However, there is a growing concern that this strategy may lead to overtreatment of a potential issue with continence as well as complications related to sling placement.

SUFU 2019: Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients with Parkinson's Disease

Miami, FL (UroToday.com) The evaluation and treatment of overactive bladder (OAB) symptoms in Parkinson's Disease (PD) patients has been challenging amongst urologists. In a moderated poster session at the 2019 SUFU Winter meeting, Gregory Vurture, MD, of New York University School of Medicine, and his group have sought to better assess urodynamic findings of PD patients with lower urinary tract symptoms (LUTS).

SUFU 2019: Long-Term Outcomes of Autologous Pubovaginal Sling for Stress Urinary Incontinence

Miami, FL (UroToday.com) The autologous fascial pubovaginal sling (PVS) has historically been reserved for challenging cases, including patients with intrinsic sphincter deficiency (ISD), recurrent stress urinary incontinence (SUI), or a history of mesh complications. However, with the advent of mesh complications related to mid-urethral slings (MUS), the use of PVS has become a viable option for patients who prefer a biologic alternative to synthetic slings.

SUFU 2019: Sacral Neuromodulation in Patients with Parkinson’s Disease: A Multicenter Study

Miami, FL (UroToday.com) Storage lower urinary tract symptoms (LUTS) are common in patients with Parkinson’s Disease, and urinary complaints in this group have been challenging to manage. Prior studies have shown limited efficacy in conservative management of LUTS in Parkinson’s Disease patients. To date, there has been no series examining the outcomes of sacral neuromodulation (SNM) in Parkinson’s Disease.

SUFU 2019: Prospective Parallel Cohort, Multi-Center Study of Solyx Single Incision Sling v. Obtryx™ II Sling for Treating Stress Urinary Incontinence in Women: 3 Year Results

Miami, FL (UroToday.com) Midurethral mesh slings are commonly used to surgically treat women with stress urinary incontinence (SUI), of which there are several types available. The Obtryx™ II sling is an outside-in trans-obturator sling (TMUS), which has been shown to have a 12-month cure of 81% based on prior studies. The Solyx single-incision sling (SIS) has been shown to have a 94.7% objective cure rate at 12 weeks on prior prospective trials. Amanda White of the University of Texas Dell Medical School presented her data on the 3-year outcomes of the Solyx SIS compared to the Obtryx II Sling at the 2019 SUFU Winter meeting.

SUFU 2019: Do We Need Gender Specific Guidelines?: Incidence of Significant Findings of Microhematuria Workup in Women

Miami, FL (UroToday.com) Asymptomatic microscopic hematuria (AMH) has been defined as ≥3 RBC/HPF on red blood cells per high-power field (RBC/HPF) on urinalysis (UA) in the absence of an obvious benign cause (e.g., infection, menstruation, vigorous exercise, medical renal disease, viral illness, trauma, or recent urological procedures). Current American Urological Association (AUA) guidelines recommend workup with a cystoscopy on patients aged 35 years and older or who have risk factors of urinary tract malignancies (e.g., irritative voiding symptoms, current or past tobacco use, chemical exposures), along with a radiologic evaluation of the upper tracts.

SUFU 2019: The Clinique Pasteur Score for Screening of Severe Obstructive Apnea Syndrome in Patients Presented with Nocturnal Polyuria

Miami, FL (UroToday.com) A study was conducted to evaluate a link between nocturnal polyuria and severe obstructive sleep apnea syndrome (OSAS). Researchers aimed to develop a novel test to identify severe OSAS in nocturic patients.

First, frequency volume charts were analyzed for the signs of nocturnal polyuria for all patients who were diagnosed with nocturia during 24-month period. 

SUFU 2019: Assessment of Transcutaneous Ultrasound in Identification of the Posterior Tibial Nerve

Miami, FL (UroToday.com) Percutaneous tibial nerve stimulation (PTNS) is a recognized treatment option for patients with urinary dysfunction. The conventional method of locating a tibial nerve includes physical palpation of the ankle. However, incorrect identification may decrease the effectiveness of PTNS therapy.

Researchers from the Mayo Clinic conducted a study to evaluate efficacy of transcutaneous ultrasound in assessment of tibial nerve location. Study sample included a total of 25 participants (7 male and 18 female) with a median age of 37 years (range, 19 -70; IQR, 31 –51).

SUFU 2019: Can We Avoid Time-Consuming Frequency-Volume Chart to Diagnose Underlying Pathophysiological Mechanisms of Nocturia in Some Patient Populations?

Miami, FL (UroToday.com) The primary purpose of this study was to assess possible causes and the overall prevalence of three primary categories of nocturia: nocturnal polyuria (NP), reduced bladder capacity, and global polyuria. Researchers state that current prevalence data is underestimated. They hypothesized that frequency volume chart (FVC) can be a potential tool to differentiate pathophysiological mechanisms behind nocturia for the tailored therapy algorithm.

SUFU 2019: Octogenarian Patients Aae Poorly Compliant with Maintenance Percutnaeous Tibial Nerve Stimulation

Miami, FL (UroToday.com) Percutaneous tibial nerve stimulation (PTNS) is a common third-line therapy for the treatment of overactive bladder, but data are scarce regarding its’ efficacy in elderly patients. This poster was presented to introduce a study of treatment effectiveness and compliance in octogenarian patients of the Stony Brook Hospital.

SUFU 2019: Increasing Therapy Effect Over Twelve Weeks With The Nuro™ Percutaneous Tibial Neuromodulation System In Drug Naïve Patients With Overactive Bladder Syndrome

Miami, FL (UroToday.com) Kathleen Kobashi, MD presented research of the effectiveness of percutaneous tibial neuromodulation (PTNM) in drug-naïve patients. A primary goal of the multicenter study was to evaluate quality of life in patients with overactive bladder symptoms after the number of therapy sessions.

SUFU 2019: Randomized Controlled Trial of PTNS versus Sham Efficacy in Treatment of Bladder Pain Syndrome

Miami, FL (UroToday.com) Interstitial cystitis/bladder pain syndrome (IC/BPS) affects about 3-8 million women. It is usually diagnosed in the fourth decade of life and comes hand in hand with other chronic pain conditions (irritable bowel syndrome, fibromyalgia, vulvodynia, etc.) and urinary urgency. The literature demonstrates that most common evaluation tools include visual analog scale (VAS), voiding diary, and O'Leary-Sant Symptom and Problem Indexes. Percutaneous tibial nerve stimulation (PTNS) was assessed in one clinical trial for the treatment of chronic pelvic pain, but not for bladder pain syndrome. The SUmiT trial headed by Kenneth Peters, MD aimed to estimate PTNS efficacy vs sham device in women with overactive bladder. Participants who were randomized to the PTNS therapy showed higher GRA response (54.5%) compared to the sham group (20.9%). 

SUFU 2019: Early Evaluation of an Implanted Chronic Tibial Nerve Stimulation Device Versus Percutaneous Nerve Stimulation for the Treatment of Urinary Urge Incontinence

Miami, FL (UroToday.com) Current prescription for the in-clinic posterior nerve stimulation (PTNS) is 30-minutes per session. However, this timeframe can potentially limit the therapeutic effect of the device. Novel neuromodulation system was tested in women with overactive bladder by the researchers from the Beaumont Hospital, Royal Oak, and Oakland University School of Medicine. 

SUFU 2019: Autologous Fascial Mini-Jupette Sling for the Management of Post-Prostatectomy Climacturia

Miami, FL (UroToday.com) In this video presentation, Dr. Choi describes the Mini Jupette Sling procedure in post-prostatectomy patients with ED and climacturia. This is for patients who are undergoing inflatable penile prosthesis surgery.  Climacturia is orgasm associated urine leakage that happens in 15-65% of this patient population.  

SUFU 2019: Real World Compliance With Percutaneous Tibial Nerve Stimulation Maintenance Therapy

Miami, FL (UroToday.com) Percutaneous tibial nerve stimulation (PTNS) is one of the treatment options for patients with voiding dysfunction. Initial prescription is for the 30-minutes weekly therapy sessions over the course of 12 month. Data suggest that maintenance course is important in preserving the therapeutic effect of PTNS, but research on actual compliance with a protocol is unknown.

SUFU 2019: A Randomized Trial of Transcutaneous Nerve Stimulation for Neurogenic Bladder Patients

Miami, FL (UroToday.com) Many therapy options are available for the treatment of urgency and detrusor overactivity, but some of them are ineffective for neurogenic bladder and OAB. Percutaneous tibial nerve stimulation (PTNS) is well recognized as a therapy for OAB, but limited data are available about transcutaneous tibial nerve stimulation (TTNS). A randomized control trial was conducted to evaluate the effects of TTNS for patients with neurogenic bladder (arm 1) and OAB (arm 2).

SUFU 2019: Has the Use of Pre-Operative Urodynamics for Stress Urinary Incontinence Surgery Changed Following the VALUE Study?

Miami, FL (UroToday.com) The Value of Urodynamic Evaluation (VALUE) study, a multi-institutional, randomized controlled trial published in 2012, suggested that routine urodynamic evaluation (URD) was not beneficial for pre-operative evaluation of uncomplicated, stress-predominant urinary incontinence (SUI). Consequently, many organizations have advocated against the routine use of pre-operative URD in index SUI patients. However, it has been unclear whether the results from the VALUE study made a clinical impact on physicians treating SUI.
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