Interstitial cystitis (IC) and bladder pain syndrome (BPS) are chronic conditions that can be debilitating for patients. There is no consensus as to their etiology, and there are many proposed treatment algorithms. Oftentimes multimodal therapy, such as combining behavioral modification and physical therapy alongside pharmacotherapies, will be utilized. With the various treatment options available to patients and providers, there is an ever-growing need to implement evidence-based therapies. Areas covered: The authors explore the different pharmacotherapies as commonly recommended in the American Urological Association (AUA) and European Association of Urology (EAU) multitiered guidelines for IC/BPS treatment as well as other investigational therapies. Pharmacotherapies targeting bladder, pelvic, and/or systemic factors in the overall treatment of IC/BPS are discussed with a particular focus on evidence-based guideline therapies. This article also looks at emerging therapies of interest. Expert opinion: IC/BPS is a syndrome that requires a multimodal approach, including clinical phenotyping and directed therapy based on the patient's symptoms. The AUA and EAU provide guidelines for practitioners to follow, but adequate treatment requires the therapy to be targeted toward the patient's phenotypic domain.
Introduction and hypothesis The objective was to assess whether telemedicine-based follow-up is equivalent to office-based follow-up in the early postoperative period after routine synthetic midurethral sling placement. Methods This is a prospective, international, multi-institutional, randomized controlled trial. Patients undergoing synthetic midurethral sling placement were randomized to 3-week postoperative telemedicine versus office-based follow-up. The primary outcome was the rate of unplanned events. Secondary outcomes included patient satisfaction, crossover from telemedicine to office-based follow-up, and compliance with 3- to 5-month office follow-up. Results We included 238 patients (telemedicine: 121 vs office: 117). No differences in demographics or medical comorbidities were noted between the study groups ( p = 0.09–1.0). No differences were noted in unplanned events: hospital admission, emergency department visit, or unplanned office visit or call (14% vs 12.9%, p = 0.85) or complications (9.9% vs 8.6%, p = 0.82). Both groups were equally “very satisfied” with their surgical outcomes (71.1% vs 69%, p = 0.2). Telemedicine patients were more compliant with 3- to 5-month office follow-up (90.1% vs 79.3%, p = 0.04). Conclusions After synthetic midurethral sling placement, telemedicine follow-up is a safe patient communication option in the early postoperative period. Telemedicine patients reported no difference in satisfaction compared with office-based follow-up but had greater compliance with 3- to 5-month follow-up.
to evaluate the prevalence of UTIs in women newly diagnosed with GSM versus women without GSM, and 2) to assess the prevalence of UTIs in women treated with prasterone versus untreated women.METHODS: This was a retrospective cohort analysis using data from Integrated Dataverse database from Symphony Health Solutions collected between 02/2015 and 06/2019. Data was analyzed from women at least 45 years old and who have at least one year of clinical data before and after their index dates. For objective 1, index dates were defined as the first observed GSM diagnosis for the GSM cohort and as a randomly selected outpatient visit date for women without a GSM diagnosis. For objective 2, index dates were defined as the first prasterone fill date for treated women and as the initial GSM diagnosis date for untreated women. To ensure women had a balanced UTI risk profile, women treated with prasterone were matched to untreated women based on age, region, diabetes history, and number of UTI episodes in the year prior to the index date. The UTI prevalence was measured over a 1-year period after the index date. The differential prevalence was assessed using risk ratios (RR).RESULTS: The prevalence of UTIs was threefold higher (RR 3.0, 95%CI 2.97-3.04) in women diagnosed with GSM compared to matched controls (N[413,207). Women with untreated GSM (N [5,813) had an increased frequency of UTI episodes in the 12 months following the first observed GSM diagnosis (p<0.05) compared to their baseline. When compared to women with untreated GSM, women treated with prasterone had a significantly lower UTI prevalence within 12 months of the first prescription fill (RR 0.62, 95% CI (0.56 e 0.68), p<0.05).CONCLUSIONS: Women newly diagnosed with GSM have a higher rate of UTIs compared to women without GSM. Results also suggest that the use of prasterone in women diagnosed with GSM may reduce the recurrence of UTIs.
There are no randomized control trials examining the role of concurrent medical therapy and BTX-A; rather, there are observational studies in the neurogenic population. Furthermore, there are two observational studies on the role of SNM in BTX-A refractory idiopathic OAB patients demonstrating its safety and efficacy. There are many options available to the patient who fails BTX-A. Further research in this specific patient population is necessary to determine why patients have suboptimal responses and to delineate the next step in treatment.
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