When your patients are willing to put forth the effort to improve their Overactive Bladder (OAB) symptoms, it is important to discuss expectations versus reality when it comes to treatment
success. Each patient who undergoes any 3rd line therapy presents different initial symptoms, although these differences may be minor, they are still different. Having differing symptoms can result in different outcomes and successes from the treatments.
What Outcomes can Patients Expect?
Up to 80% of patients respond to percutaneous tibial nerve stimulation (PTNS), with the use of Urgent PC. MacDiarmid and Staskin performed a meta-analysis of seven PTNS studies, involving 244 patients, and found that patients saw measurable improvements, those being:
- Voids per day decreased 23 percent
- Voids per night decreased 41 percent
- Voiding volume improved 43 percent
- Incontinence episodes decreased 45 percent
Read more about clinical outcomes with Urgent PC.
Of course, everyone wants to be “cured” but we often hear from practitioners that it’s just a matter of patient education, and setting realistic expectations. Our clinician bloggers have highlighted some key areas they focus on with their patients as they start, and continue, PTNS treatment. For example, Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD, suggests you help patients keep their eyes on the prize by setting practical goals and possible outcomes:
- Decreased frequency and/or urgency
- Dry all day
- Dry all night
- Sleep all night
- No embarrassing accidents
- No dribbling
- Voiding every couple of hours
It is also important for patients to understand what are normal improvements and the impact of the aging bladder. Do your patients realize that voiding 6-8 times a day is normal, and for older adults getting up once during the night is also normal? Diane K. Newman, RNC, MSN, CRNP, FAAN, notes that you may have patients with unrealistic goals, because for years they have only voided 2-3 times per day. Now they are going 6 times and they think this is abnormal but your voiding frequency typically increases as you age – with or without OAB.
Age does a number on the bladder, and it may not be able to tolerate bladder irritants like it used to. Wooldridge advises providers to discuss a “new normal” with their patients. She explains, “As we age, our bladders hold less urine, there are more uninhibited contractions, bladder flow/ force of bladder contractions is less and the kidneys manufacture more urine at night.”
Celebrate Small Victories
As their provider, it is important that you educate them, as well as be their advocate. Remember you are the expert that can guide them, and be available when they are not feeling great about their outcomes. Patients may wish to sleep through the night uninterrupted, but they are still waking up feeling the urge to use the rest room. Realistically with OAB, and other age related factors, this goal may not be attainable. In times like this, it is essential to focus on the improvements they have achieved.
Wooldridge writes about celebrating all small victories:
For example, if they are sleeping an extra hour or two and their second or third time getting up is at 4:00 or 5:00 am instead of 2:00 or 3:00 am, that’s progress. Are they are wearing 3 pads a day instead of 5? Is the amount of leakage less? Are they not leaking through their pads onto their sheets or through their clothes? Can they stand up from a chair and get to the bathroom without leaking? Do they leak less? Are they able to go out of their home without the fear of wetting all over themselves? Are their behavioral management interventions starting to work better too?
Focus on Success
Remembering to discuss with your patients what their “new normal” possibilities will be is important from the beginning. Educating them on what types of success they can achieve will also allow you to create a positive and successful experience. If you maintain transparency with your patients you will prevent unrealistic expectations and reduce the risk of potential discouragement. Urgent PC is shown to be an effective treatment for the majority of OAB patients. Help ensure patient success by setting goals, managing expectations and celebrating the victories along the way.
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 PC is a registered trademark of Cogentix Medical © 2016 Cogentix Medical. All rights reserved.