It’s no wonder that drug therapy is the most prescribed treatment for OAB sufferers—the medications work, are inexpensive, and easy to administer.
But every treatment comes with its own set of pros and cons. Keep in mind the following considerations when prescribing OAB drugs and managing your patient’s OAB treatment plan.
Adherence and Side-Effects
Published research shows that one of the most common issues with prescribing drugs to treat the symptoms of OAB is that many of the patients stop taking the medication--80% by the end of the first year, the majority of them within the first 90 days.
Even if the drug helps, patients struggle to tolerate the irritating side-effects. How do you manage the common complaints about dry mouth and constipation, or other problems like blurred vision and central nervous system side-effects? Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD, discusses balancing efficacy and side-effects when using OAB drugs and when a 3rd line therapy might supersede the use of medication.
Issues in the Elderly
Using medication to treat OAB in men and women over age 65 can be challenging due to the number of drugs patients are already taking to treat other conditions. Check out this blog to learn more about the impact polypharmacy can have on elderly patients, including falls, hip fractures and confusion.
The American Geriatric Society recommends avoiding or using caution before prescribing anticholinergics to elderly patients. For details, check the updated Beers Criteria list for the most up to date information.
Even if your patient’s side-effects are minimal, long term use of anticholinergics – the largest class of drugs used to treat OAB syndrome – is under increased scrutiny. A prospective long-term study published in the Journal of the American Medical Association linked long-term anticholinergic use to higher incidences of dementia and Alzheimer’s disease. The study showed that 23.2% of the elderly patients taking anticholinergics during a seven year period developed dementia, and a staggering 79.9% of those patients developed Alzheimer’s. The report also notes that the effects may not be reversible after patients stop taking the medication.
Urgent PC is a non-drug, non-surgical alternative
Drugs can be a powerful tool, but sometimes patients need more than one approach to reach their goals. Percutaneous Tibial Nerve Stimulation (PTNS) with Urgent PC is an effective 3rd line treatment for patients who are elderly, refractory to drugs, or uninterested in surgery. And, PTNS with Urgent PC has no severe side-effects in comparison to other OAB treatments. Only 14% of the patients in the Investigational Device Study (IDE) experienced side-effects that were transient and minor.
But is it effective? There are over 50 major studies that demonstrate the proven performance of Urgent PC including one that compares Urgent PC and tolterodine tartrate extended release. Results of the controlled study of 100 patients across the U.S. showed the Subject Global Response Assessment (GRA) was statistically higher for Urgent PC subjects (79.5%) compared to drug subjects (54.8%) with a p value=0.01.
If you decide to implement a 3rd line treatment, Leslie Wooldridge recommends tapering refractory patients between antimuscarinics and PTNS therapy rather than having them quit cold turkey. Long term, Wooldridge recommends developing your own protocol for how and when you transition your patients off their OAB drugs and provides insight into her own process while discussing a specific case and how she successfully tapered a patient off OAB medication.
Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at www.cogentixmedical.com. Urgent is a registered trademark of Cogentix Medical © 2016 Cogentix Medical. All rights reserved.