The 2015 updated OAB guidelines added intravesical botox, PTNS, and SNM. Sacral nerve targets have advanced since then. He reviewed the Nuvectra Virtis SNM system with dual leads, is rechargeable, and has multiple current sources. He state this system may be more durable when placing or revising. Another new technology is the Axonics neuromodulation, which is similar to Medtronic’s Interstim. It differs in that it is smaller, rechargeable, and necessitates a smaller lateral incision. The system is charged once every 2 weeks, so the IPG can last longer and this will decrease the frequency of revisions. Medtronic is continuing to come up with innovations, focused on a rechargeable, smaller IPG, with full body MRI conditional labeling. There is also a commercial off the shelf controller, which will be able to transmit a lot more information to the clinician.
Tibial nerve technologies for OAB are needed for improvement in patient compliance, and to attempt better success rates. The StimGuard Implantable is a wireless tibial microimplant, performed in the office. It comes with a potential for advanced, wearable technology. The eCoin Valencia technology is a fully implantable, primary battery (not rechargeable), which is the size of a nickel. It is implanted subcutaneously and stimulated intermittently, which allows for longer battery life. The new BlueWind implantable tibial nerve simulator is now in FDA approval stages. Bioness is an implanted lead with external pulse transmitter, for treatments 3-7 times per week. In other technologies for OAB, Amphora uses a cystoscopic procedure for radiofrequency administered to sub-trigonal region of the bladder, in order to disrupt OAB contractions. In new technologies for SUI, BioTextiles has been developed for slings and Enobosarm is new for the medical management of SUI.
BioTextiles is a reversed engineered pure biological graft for GU reconstruction, which even holds the potential for drug delivery. Enobosarm employ’s SARM’s, in which biology driven selectivity is used to build pelvic floor muscles and reduce the severity of SUI. There are phase 2 placebo controlled clinical trials underway to investigate this innovation now. Innovations in robotic surgery focuses on single port surgery, which has already been done in prolapse. It has been difficult because instrumentation is not ideal and requires an advanced skill set. Technologies are progressing, as patients are preferring more minimally invasive therapies, as they desire improved cosmesis. Intuitive is currently developing a single port robot, with adaptable instruments. Innovations in this field are accelerating at an amazing pace and will serve to access a larger patient population.
Presented by: Sandip P. Vasavada, MD
Written by: Cristina Palmer, DO. Female Urology, Pelvic Reconstruction, Voiding Dysfunction Fellow, Department of Urology, UC Irvine Medical Center, Orange, California at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas