Poster, Podium & Video Sessions
Presentation Authors: Karen Noblett*, Riverside, CA, Jeffrey Mangel, Cleveland, OH, Craig Comiter, Stanford, CA, Samuel Zylstra, Whitinsville, MA, Erin T. Bird, Temple, TX, Tomas L. Griebling, Kansas City, KS, Daniel Culkin, Oklahoma City, OK, Suzette E. Sutherland, Seattle, WA, Kellie Berg, Fangyu Kan, Minneapolis, MN, Steven Siegel, Woodbury, MN
Introduction: This analysis aims to describe the use of concomitant overactive bladder (OAB) medications following implant of the sacral neuromodulation (SNM) InterStim® system. Subjects with bothersome symptoms of OAB including urinary urge incontinence (UI) or urgency-frequency (UF), who had not exhausted all medication options (failed at least 1 anticholinergic medication and had at least 1 medication not tried) were included in the InSite study.
Methods: Subjects were restricted from taking OAB medications for the first 6 months post-implant. Concomitant use of OAB medications was allowed after 6 months. At each visit, data were collected on OAB medications used since previous visit. The number of implanted subjects who used any concomitant OAB medication post-implant is summarized by medication type. Baseline characteristics were compared between implanted subjects with and without concomitant OAB medication use during any time between implant and 5-years follow-up. Logistic regression was used to assess the effect of concomitant OAB medication use on 5-year therapeutic success in UI and UF subjects respectively.
Results: Of 272 subjects that were implanted, 91% were female and the mean age was 57 years. A total of 73 subjects used any concomitant OAB medications between 6 months and 5 years post implant; the most commonly used medications were mirabegron, oxybutynin, and solifenacin. At baseline, subjects qualified more frequently as both UI and UF in the group with concomitant OAB medication use vs. the group with no concomitant OAB medication (54% vs. 44%, p=0.0479), and subjects with concomitant OAB medication use were older (mean age of 60.5 vs 55.6, p=0.0163). When assessing the effect of concomitant OAB medications use on therapeutic response with baseline characteristics and test stimulation response adjusted, UI subjects were less likely to have 5-year therapeutic success if they had concomitant OAB medication use compared to those who didn't (Odds Ratio=0.28, 95% Confidence Interval 0.10-0.80, p=0.0171). No relationship between concomitant OAB medication use and UF therapeutic response was observed.
Conclusions: This result shows that a small portion of subjects implanted with InterStim use concomitant OAB medications post implant. However, the presence of OAB medications after implant does not improve long term therapeutic success. In UI subjects, the association between concomitant OAB medication use and poorer long term therapeutic success might indicate that a subset of subjects with symptoms remain refractory even with addition of OAB medications.
Source Of Funding: This study was sponsored by Medtronic
University of Washington School of Medicine
Suzette E. Sutherland, MD, MS, FPMRS is Director of Female Urology, a member of the UW Medicine Pelvic Health Center, and Associate Professor at the University of Washington School of Medicine in Seattle, WA. As a leader in this field, she is part of the first group of female urologists/urogynecologists to be board certified in the subspecialty of Female Pelvic Medicine & Reconstructive Surgery through the American Board of Urology/American Board of Obstetrics and Gynecology. She completed her medical degree and urologic training at Case Western Reserve University School of Medicine/University Hospital of Cleveland in Ohio. Dr. Sutherland has gained further specialty training in female urology to include urinary incontinence, voiding dysfunction, urodynamics, neuromodulation, pelvic prolapse and reconstructive surgery, pelvic floor disorders and female sexual dysfunction from the Center for Continence Care in Minneapolis/St. Paul, MN, and from the Institute for Sexual Medicine in Boston. She has made numerous contributions to the literature in the form of presentations, papers and book chapters on urinary incontinence, pelvic prolapse and sexual health, and takes an active role in training future female urologists both at the resident and fellowship level. Serving as a consultant for pharmaceutical and medical device companies, she provides her expertise and innovative ideas for the future development of female urology. Dr. Sutherland remains active in associated clinical research, staying abreast of the newest developments in her field, thereby providing the most up-to-date treatment options for her patients.
Dr. Sutherland is an active member of the AUA, WS/AUA, Northwestern Urology Society, Minnesota Urologic Society (President 2012-2013), Society for Women in Urology (Current President-Elect), Society for Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, American Urogynecology Society (Surgical Mesh Special Interest Group), International Continence Society, International Urogynecology Association, and International Society for the Study of Women’s Sexual Health.
Friday, May 12
1:35 PM – 2:00 PM
Saturday, May 13
9:30 AM – 11:30 AM
Monday, May 15
3:30 PM – 5:30 PM