19 January 2024

United Kingdom





Sacral Neuromodulation or Botulinum Toxin for Refractory OAB


This interactive online course was chaired by:

During this session best practices for choosing between SNM and BTX for the treatment of refractory OAB will be discussed by a range of international ICS experts. They will also examine the literature comparing these treatments and teach attendees how to identify which patients may benefit most from each treatment and how to move patients along the treatment pathway effectively.

This webinar was been sponsored by Medtronic and registration was free.



Time Title
13:00 - 13:03 Introduction
13:03 - 13:05 Case presentation and voting
13:05 - 13:15 Which patient with refractory OAB should get SNM
13:15 - 13:18 Case presentation and voting
13:18 - 13:25 Which patient with refractory OAB should get BTX
13:25 - 13:30 Questions for audience and voting
13:30 – 13:40 What does the data show for SNM vs BTX – Rosetta in particular
13:40 - 13:45 Case presentation and voting
13:45 - 13:55 Why are patients not moving along treatment algorithm, How to present options, How to move patients along treatment
13:55 - 14:15 Panel discussion, respond to audience question

Record of Questions and answers

Question Answer
Valerio Vagnoni: Is there any cut off for the disease factors when considering botulinum to in injectioon? Arun Sahai: I would not suggest any specific disease factors required. Many would give to those with wet OAB but certainly Botox will work well for frequency and urgency without leakage. Same is true for SNM.
Sarah Dix: With an implantation site pain rate of 15%, would you be cautious in recommending SNM to someone who already has a chronic pain condition e.g. fibromyalgia? Arun Sahai: Yes we have to be careful. Battery site and lead site pain is usually lower than 15%. But agree those with chronic back issues and other pain related problems are probably more likely to experience pain in general. Thee is no data but my experience would suggest that. So counselling is key.
Sarah Dix: Thank you - what pain rate would you quote? Arun Sahai: 2-5%
Dean Elterman: Agree <5%
Anonymous Attendee: How many BTX injections required over a 15 year period for a patient? Arun Sahai: That will depend on the individual or and how long the injections last for. Typically they last 6 months if 100u. But could be shorter or even longer. It is not recommended to re-inject before 3 months.
Dean Elterman: Theoretically, patients on average receive Botox injections every 6 months. Assuming good response and no discontinuation, that’s 30 treatments
María Belén Maza: Wich is the average battery life and which percentage of patients require battery replacement? Arun Sahai: Newer kits from Medtronic claim Battery life of 15 years; previously was 5-7 years but depends on usage and stimulation parameters.
Dean Elterman: The new primary cell batteries (non-recharge) now have very long lives. Depending on how high they are set, a battery can last around 15 years.
Ellen Afriyie Mensa-Bonsu: can Physiotherapy be performed while someone is on SNM? Dean Elterman: Yes, pelvic physio is always a great adjuct and can safely be done with an SNM in place
Hanne Kobberø: Very interesting discussion about the long period from symptoms to final successful treatment probably based on ingnorance from both the patients and practioners. OAB is not a "sexy" diagnosis and if you don´t know anything about all of the treatments possibilities you do as usual. What are your suggestion of doing it better? Arun Sahai: Big piece of work on raising awareness and education. National level. Not easy. The info Needs to hit the public and to community doctors.
Dean Elterman: Also training more physicians per perform SNM and Botox. It does not have to remain in the hands of a few. Broader access is needed
María Belén Maza: in your experience, which percentage of patients require battery replacement? Arun Sahai: They will all need replacing at some point. If battery funds out - 5-15 years span depending on system. You may need revision surgery for other reasons eg pain, infection but revision rates long term are low at around 15% or so runs out.
Christine Magno: thank you , Urogynaecology Lonodn Roger Blackmore: Thank you very much for joining us Christine, see you next time.

Record of Chat

00:48:38 Roger Blackmore ICS: Greetings and welcome to this Masterclass! Use the chat to say hello and tell us where you're watching.

00:49:20 Roger Blackmore ICS: You can ask your questions via Zoom's Q&A button at any time. Our panel will answer you as soon as possible.

00:49:26 Pradip Subedi: Hello everyone. I am watching in London.

00:49:49 Ellen Afriyie Mensa-Bonsu: hello everyone i am ellen watching from Ghana

00:50:02 Zineddine Taha: hello Taha PMR Resident i'm watching in Casablanca morocco

00:51:29 Roger Blackmore ICS: Greetings to all, it's great to see you here.

00:51:32 Ellen Afriyie Mensa-Bonsu: Hi, I'm an AI assistant helping ELLEN MENSA-BONSU take notes for this meeting. Follow along the transcript here: https://otter.ai/u/7wbV0Q54jWQRAAHBANYyvEDn6rM?utm_source=va_chat_link_1
You'll also be able to see screenshots of key moments, add highlights, comments, or action items to anything being said, and get an automatic summary after the meeting.

00:56:45 Ahmad Abdelfattah Abdel Hafez al-Aqrabawi: hi I am ahmad from Jordan

01:10:19 Matt Carr: Marie, thank-you for your talk. I'm interested in Shared Decision Making - practically, what does that look like in Nantes?

01:39:47 Arun Sahai: That will depend on the individual or and how long the injections last for. Typically they last 6 months if 100u. But could be shorter or even longer. It is not recommended to re-inject before 3 months.

01:44:22 Roger Blackmore ICS: Thanks Zbig, yes, the recording of this Masterclass will be available on the ICS website early next week. You will receive an email with the link in the next few days.

02:26:57 Roger Blackmore ICS: ICS would like to thank you all for joining us today. We hope you found the presentations and discussion stimulating, and we look forward to welcoming you to ICS Masterclasses in the future: to receive updates, please visit www.ics.org/subscribe.

02:27:09 Roger Blackmore ICS: A special thank you to our sponsor Medtronic for supporting our work in this area.

02:27:14 Roger Blackmore ICS: Likewise, a huge thank you to Howard Goldman, Marie-Aimee Perrouin-Verbe, Ashani Couchman, Arun Sahai, and Dean Elterman, our excellent panelists.

02:27:33 Roger Blackmore ICS: The Masterclass would greatly benefit from any feedback you can provide using the following survey: http://www.surveymonkey.com/r/PXLVLGN

02:27:38 Roger Blackmore ICS: Until next time, take care and see you soon.

Please note, this course is open to healthcare professionals only. This educational course will provide teaching on different surgical techniques, but this does not mean an endorsement of that procedure by the ICS. Endorsement of techniques fall under the remit of national government healthcare organisations. The aim of ICS is to provide education regarding good surgical technique.

15/06/2024 07:09:15  26817
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