Overactive Bladder

Overactive Bladder (OAB) is a common urinary condition affecting men and women alike. Symptoms include the uncontrollable urge to urinate, frequent daytime urination and getting up at night to urinate. It is common for these symptoms to be accompanied by leakage of urine (urinary incontinence). These symptoms can cause undesired changes in the work environment, social settings and lead to an overall decrease in quality of life.

Overactive Bladder (ROAB) Treatment

There is now a range of treatment options available

• Conservative therapies
• Dietary elimination
• Behavioral modifications
• Bowel regulation
• Bladder retraining
• Physical therapy
• Weight loss

Oral therapies include

• Anticholinergics
• Beta-3 adrenergics

Patients who fail or are intolerant to conservative and oral therapies are considered to have refractory overactive bladder (ROAB). Historically, these patients have had few options, but in the last decade, new therapies like injections and nerve stimulation have become available.

Injections

Botox (onabotulinumtoxinA) for the Bladder

In 2013, the FDA approved onabotulinumtoxinA (Botox) bladder injections for patients with refractory overactive bladder. Botox blocks nerve signals in the bladder muscle, reducing ROAB symptoms. Botox injections are performed in the office setting under local anesthesia or in an outpatient surgery center with sedation.  Side effects can include pain with urination, urinary tract infection, or difficulty urinating, requiring the temporary use of a catheter.

Nerve Stimulation

Percutaneous Tibial Nerve Stimulation (PTNS)

Approved in 2010 by the FDA, PTNS is an office-based procedure indirectly targeting the nerves to the bladder and pelvic floor. This is a low-risk therapy available to almost every patient.  Therapy involves the placement of a thin needle electrode into the ankle. During a thirty-minute treatment, the needle stimulates the nerves in the pelvis with mild electrical impulses. This process of neuromodulation results in an improvement in ROAB symptoms.

Sacral Nerve Stimulation (SNS)

Sacral nerve stimulation was FDA-approved in 2007. This effective treatment necessitates the implantation of a metal device (neurotransmitter) in the buttock to directly stimulate the sacral nerve plexus. Through this neurotransmitter, electrical impulses are sent directly to the sacral nerves. The sacral nerves provide intervention to the bladder and thus the impulses aid in symptom reduction for patients with ROAB.