Bladder Health: From the Editor
The Effectiveness of “Placebo” in Current Medical Research
The International Continence Society (ICS) 2020 online meeting opened with a presentation by Dr. Alan Wein, previous Chief of Urology at the University of Pennsylvania, now Director of the Penn Urology Residency Training Program. Dr. Wein presented an informative lecture on the effectiveness of the “placebo” in clinical research. He reviewed the results of the proof of concept study of stress urinary incontinence (SUI) in post-menopausal women with an enobosarm (GTX-024), a synthetic androgen receptor analog, presented previously at the 2017 International Continence Society (ICS) and the 2018 American Urological Association (AUA) annual meetings.
November is Bladder Health Month - What the New York Times Got Right
To start off Bladder Health month, I thought a discussion about urinary incontinence, a bladder concern of many women, especially those who have undergone pregnancy, would be appropriate. Pregnancy and childbirth are known risk factors for urinary incontinence (unintentional and involuntary loss of urine). But despite the fact that more than one-third of women experience urinary incontinence in the second and third trimesters of pregnancy and about one-third leak urine in the first three months after giving birth, the topic is widely avoided.
Growing Old with an Overactive Bladder
I recently saw a 77 year-old Latina woman with complaints of strong urinary urgency resulting in incontinence, frequency every 2 hours with nocturia x4. She described urgency as “pressure in my bladder.” She reported that her symptoms were “terrible.” Her symptoms were longstanding but appeared to be worsening. She had undergone lumbar spinal fusion 18 months ago, her third back surgery. This was about the time symptoms worsened.
Prostate Cancer Treatment Outcomes: What Men Need to Know
A major part of my practice is treating men with prostate cancer (PCa) who are experiencing stress urinary incontinence (SUI), urine leakage with effort, when laughing, coughing, exercising, etc. SUI following PCa surgery (robotic or open prostatectomy) is a complication seen in a subset of men.
Effective Method for Men with An Overactive Bladder
I see many young and older men with complaints of overactive symptoms of urgency and frequency. The older men may have benign prostatic hyperplasia (BPH) and the younger men seem to have no underlying pathology. Whatever the cause, these are distressing symptoms that affect the quality of life for all of these men. Drug therapy is usually recommended at first with behavioral therapy added usually as an afterthought. But based on a recently published research in JAMA by Burgio and colleagues, clinicians should consider a more effective stepped approach to combination overactive bladder (OAB) therapy by first recommending behavioral therapy.1
The New York Times Is Right: Incontinence Is NOT Inevitable
Voiding (Peeing): An Embarrassing Bodily Function
Urination is not part of daily conversations, especially for girls and women. A skit performed on SNL (Saturday Night Live) on the 7th of July, 2019, revolved around the problem of nocturia in men. It presented the “PottyPM” device that allows for uninterrupted sleep for men. The device looked antiquated, like an external male “Texas” catheter.
UTIs (Bladder Infections) – The Call for Prevention
Chief Complaint: “I Am Up All Night” – How Should You Respond
Women Beware: Not All Mesh-Implants Need to Be Removed
The article is an exposé on the practice of marketing unnecessary mesh-implant removal to women who may or may not have mesh-related complications from the surgery. Through some unexplained access, marketing firms are able to obtain lists of women who have undergone pelvic surgery and who have received mesh implants. They randomly contact these women to encourage removal of the mesh. The women are lead to believe the mesh is harmful, even though the woman may not have complications from the implant. These firms provide upfront cash to cover travel to an “expert surgeon” who removes the mesh. The women are lead to believe that they will receive large legal settlements from companies making the mesh implant. What they end up with is a loan with a high-interest rate and in many cases, new or worsening complications following mesh removal. This appears to be a highly profitable business with financial backing from banks, private equity firms, and hedge funds. I happen to be a provider who sees women who are seeking help for post-mesh-implant complications, such as urinary incontinence and pelvic pain. So I can relate to the women profiled in the article, who are now dealing with these same complications. For patients beware and see your trusted clinician.
Written by: Diane Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practitioner (NP), Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials, Division of Urology, Adjunct Professor of Urology in Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Published Date: August 14th, 2018
Further Related Content:
How Profiteers Coax Women Into Surgery, in the New York Times
It Works Like Clockwork
Discouraged Patients, Frustrated Clinician!
The first patient was James, a 74-year-old man who was referred for Percutaneous tibial nerve stimulation (PTNS) treatments, having failed 2 injections of Botox and multiple overactive bladder (OAB) medications. He had refused an Interstim implant. James was tolerating his