These options can be life-changing, but not all people with OAB need them.
The majority of the time, overactive bladder (OAB) can be managed with lifestyle tweaks or medications for OAB. For example, kegels and bladder training may be enough for many people with OAB to regain their continence and prevent urgency or leaks.
However, some people with OAB may need more treatment. “If a patient has tried medications and they’re not working, there are some surgical options for overactive bladder,” says Lauri Romanzi, MD, urogynecologist in New York City. The surgeries available to treat OAB include a botulinum toxin injection and a neuromodulation pacemaker.
Botulinum toxin is injected into different points in the bladder using a small fiber optic tube. “Once [the medication] in, as with any part of the body, it relaxes the muscle, and this can help reduce overactive bladder symptoms,” says Dr. Romanzi. (Learn more about botulinum toxin injection for OAB here.)
Neuromodulation pacemaker (or bladder pacemaker) is a small implant that attaches to the hip area to control your void reflex using a remote control. “It’s turning out to be a very good rescue therapy for patients with severe overactive bladder who have poor to minimal responses to anything else,” says Dr. Romanzi.
Having surgery for OAB is considered an extreme option that comes with pros and cons; in general, it’s considered beneficial only for those with severe OAB symptoms that are disrupting their quality of life and that have not improved with behavioral modifications.
However, the earlier you begin treatment for OAB, the better you’ll respond to behavioral modifications for OAB—and the less likely you’ll need surgery. “You’re not helping yourself by waiting; you’re simply making yourself resistant to more and more therapeutic options,” says Dr. Romanzi.
Dr. Romanzi is a urogynecologist and reconstructive pelvic surgeon based in New York City.
00:00:01,856 --> 00:00:05,810
If a patient has tried medications and
they're not working,
00:00:05,810 --> 00:00:09,546
there are some surgical options for
00:00:09,546 --> 00:00:13,717
00:00:13,717 --> 00:00:17,491
Severe overactive bladder
usually needs medications.
00:00:17,491 --> 00:00:22,328
And severe overactive bladder that doesn't
respond to medication usually needs
00:00:22,328 --> 00:00:25,212
a neuromodulation bladder pacemaker.
00:00:25,212 --> 00:00:29,648
A botox injection is injected into
the bladder through something called
00:00:29,648 --> 00:00:30,600
00:00:30,600 --> 00:00:34,810
A small fiberoptic tube is inserted
through the urethra into the bladder and
00:00:34,810 --> 00:00:38,032
then through this tube,
a very tiny needle is inserted and
00:00:38,032 --> 00:00:41,274
the botox is injected at
different points in the bladder.
00:00:41,274 --> 00:00:45,625
Once it's in, as with any other part
of the body, it relaxes the muscle.
00:00:45,625 --> 00:00:48,589
And this can help reduce
overactive bladder systems.
00:00:48,589 --> 00:00:52,974
The other surgical option for overactive
bladder is called neuromodulation, or
00:00:52,974 --> 00:00:55,525
more simply put,
a pacemaker for the bladder.
00:00:55,525 --> 00:00:59,482
It's a small implant that
goes into the hip area and
00:00:59,482 --> 00:01:02,439
you control it with a remote control.
00:01:02,439 --> 00:01:06,074
It works very well for
patients who are properly selected.
00:01:06,074 --> 00:01:11,453
And it's turning out to be a very good
rescue therapy for patients with severe
00:01:11,453 --> 00:01:16,597
overactive bladder who have poor to
minimal responses to anything else.
00:01:16,597 --> 00:01:21,949
Overactive bladder with or without urgency
incontinence needs to be evaluated and
00:01:21,949 --> 00:01:24,327
treated earlier rather than later.
00:01:24,327 --> 00:01:26,250
You're not helping yourself by waiting.
00:01:26,250 --> 00:01:30,561
You're simply making yourself resistant
to more and more therapeutic options.
00:01:30,561 --> 00:01:32,360
The earlier you come in,
00:01:32,360 --> 00:01:37,596
the more likely you are to be able to
avoid those more extreme therapies.
00:01:37,596 --> 00:01:42,394
AUA releases guideline on diagnosis and treatment of overactive bladder. Am Fam Physician. 2013 Jun 1;87(11):800-3.
Treatment of urgency incontinence/overactive bladder in women. Waltham, MA: UpToDate, 2019. (Accessed on May 6, 2019 at https://www.uptodate.com/contents/treatment-of-urgency-incontinence-overactive-bladder-in-women.)