Purpose To determine if women with overactive bladder (OAB) requiring 3rd line therapy demonstrate greater central sensitization, indexed by temporal summation to heat pain stimuli, than those with OAB. Materials and Methods We recruited 39 adult women with OAB from the Urology clinic who were planning to undergo interventional therapy for medication refractory OAB with either onabotulinumtoxinA bladder injection or sacral neuromodulation and 55 women with OAB, either newly seen in our Urology clinic or responding to advertisements for study participation. Participants underwent quantitative sensory testing using a thermal temporal summation protocol. The primary study outcome was the degree of temporal summation, as reflected in the magnitude of positive slope of the line fitted to the series of 10 stimuli at a 49°C target temperature. We compared the degree of temporal summation between study groups using linear regression. Results Women in the group undergoing 3rd line therapy demonstrated significantly higher standardized temporal summation slopes compared to those in the nontreatment group (beta = 1.57, 95% confidence interval = .18 - 2.96, t = 2.25, p = .027). On exploratory analyses, a history of incontinence surgery or hysterectomy were factors associated with significantly greater temporal summation. Conclusions In this study, the degree of temporal summation was elevated in women undergoing 3rd line OAB therapy compared to women with OAB not undergoing 3rd line therapy. These findings suggest there may be pathophysiologic differences, specifically in afferent nerve function and processing, in some women with OAB.

Antimuscarinic medications are used to treat nonneurogenic overactive bladder refractory to nonpharmacologic therapy. Side effects such as dry mouth, constipation, blurred vision, dizziness, and impaired cognition limit the tolerability of therapy and are largely responsible for high discontinuation rates. Oxybutynin is a potent muscarinic receptor antagonist whose primary metabolite after first-pass hepatic metabolism is considered largely responsible for its associated anticholinergic side effects. Transdermal administration of medications bypasses hepatic processing. Specifically with oxybutynin, whose low molecular weight permits transdermal administration, bioavailability of the parent drug with oral administration is less than 10%, whereas with transdermal delivery is a minimum of 80%. The result has been an improved side effect profile in multiple clinical trials with maintained efficacy relative to placebo; however, the drug may still be discontinued by patients due to anticholinergic side effects and application site reactions. Transdermal oxybutynin is available as a patch that is changed every 3-4 days, a gel available in individual sachets, or via a metered-dose pump that is applied daily. The transdermal patch was briefly available as an over-the-counter medication for adult women, although at this time all transdermal formulations are available by prescription only.

Postoperative oral antibiotics are prescribed to nearly two-thirds of patients but are not associated with reduced odds of explant following IPP or AUS placement. Given the risks to individuals associated with use of antibiotics and increasing bacterial resistance, the role of oral antibiotics after prosthetic placement should be reconsidered and further studied in a prospective fashion.

Purpose: Resumption of elective urology cases postponed due to the COVID-19 pandemic requires a systematic approach to case prioritization, which may be based on detailed cross-specialty questionnaires, specialty specific published expert opinion or by individual (operating) surgeon review. We evaluated whether each of these systems effectively stratifies cases and for agreement between approaches in order to inform departmental policy. Materials and Methods: We evaluated triage of elective cases postponed within our department due to the COVID-19 pandemic (March 9, 2020 to May 22, 2020) using questionnaire based surgical prioritization (American College of Surgeons Medically Necessary, Time Sensitive Procedures [MeNTS] instrument), consensus/expert opinion based surgical prioritization (based on published urological recommendations) and individual surgeon based surgical prioritization scoring (developed and managed within our department). Lower scores represented greater urgency. MeNTS scores were compared across consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores. Results: A total of 204 cases were evaluated. Median MeNTS score was 50 (IQR 44, 55), and mean consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores were 2.6AE0.6 and 2.2AE0.8, respectively.