Selective bladder denervation shows potential for treating refractory OAB in women
Selective bladder denervation provides a minimally invasive treatment option for female patients with refractory overactive bladder (OAB), with data from two prospective feasibility studies showing that the intervention improves symptoms over 6 months of follow-up.
The total population comprised 35 women (mean age 66 years) with refractory OAB and urgency urinary incontinence (UUI) who received selective bladder denervation of the subtrigonal region containing afferent sensory nerves. Patients were followed for 6 months and evaluated for OAB symptoms, health-related quality of life measures and adverse events.
All selective bladder denervation procedures were successfully completed, and symptom improvements based on 3-day bladder diaries were seen over the follow-up period. Specifically, UUI improved by 59 percent from baseline (p<0.001), urinary incontinence by 59 percent (p<0.001), urgency by 39 percent (p<0.001), urinary frequency by 9 percent (p=0.01), and total urgency and frequency score by 27 percent (p<0.001). The majority of these treatment benefits were observed in as early as the first month following treatment.
The rate of clinical success, defined as ≥50-percent reduction in UUI, was 70 percent. Treatment benefit was reported in 75 percent of patients, and the dry/cure rate was 27 percent.
Additionally, statistically significant increases in health-related quality of life were observed over 6 months, as reflected on Symptom Bother and Health-related Quality of Life scales on the OAB questionnaire, as well as on all domains of King’s Health Questionnaire except general health perception.
In terms of safety, device- or procedure-related adverse events occurred in six patients (17 percent).
A minimally invasive selective bladder denervation device includes a disposable transurethral instrument that accepts a rigid endoscope for visualization and has a lumen to facilitate addition and removal of fluids in the bladder. At the end of the lumen is a suction paddle that works to stabilize of the tissue and deliver the radiofrequency electrodes. [Neurourol Urodyn 2018;37:2097-2105]