Urinary leakage is a common but chronic and debilitating condition. One in four women suffer from overactive bladder while one in five women experience bothersome stress urinary incontinence. Often patients can be negatively affected by both. Constantly feeling a strong urge to go to the bathroom, not being able to make it there in time, waking up in the middle of the night to urinate, or significant loss of urine while coughing, sneezing, laughing or exercising, are all symptoms that can drastically impair quality of life. Sansum Clinic Urologist Alexandra Rogers, MD is now using newly-approved, groundbreaking therapies to address these prevalent and vexing urinary problems. “These new therapies approved in the last few months are changing the landscape of how we treat and manage stress urinary incontinence, overactive bladder and even bowel incontinence.” reports Dr Rogers.
The first line of treatment for overactive bladder or OAB usually involves behavioral changes like fluid reduction and timed voiding, or pelvic physical therapy. Sansum Clinic has a dedicated pelvic floor physical therapist, Taisa Skovorodko, DPT, for women who choose this option. Medications can be a second line of treatment however the oral daily pills are only utilized by 20% of OAB patients due to lack of effectiveness, side effects and/or high cost. When these initial options fail, Dr. Rogers will consider 3rd line therapies including Botox® injections of the bladder, percutaneous tibial nerve stimulation and sacral neuromodulation surgery. Approved by the FDA in the fall of 2019, Axonics® Therapy is a new sacral neuromodulation system which uses an implantable battery the size of a quarter. In a minimally-invasive outpatient surgery, the device is inserted on the backside and operates like a pacemaker, sending out automatic small pulses of stimulation which improve bladder and/or bowel control “With its rechargeable battery, Axonics® Therapy has an expected life of 15 years in the body, which decreases the need for repeat or multiple surgeries. Its prior competitor required pacemaker replacement every 4 to 7 years,” explains Dr. Rogers. In a clinical trial of 129 patients in 19 centers, 90% of those who received Axonics® Therapy experienced significant improvement of their symptoms at 6 months. Axonics treats symptoms of overactive bladder, urinary retention and fecal incontinence. An added benefit, patients with an Axonics® Therapy device can undergo full-body magnetic resonance imaging or MRI, while the older technology does not allow for MRI below the neck. Currently, Dr Rogers is the number one implantor of Axonics in the state of California.
For patients bothered by stress urinary incontinence, Dr. Rogers is now offering Bulkamid® which received FDA approval in January 2020. Bulkamid® is a soft water-based gel, which is found in many cosmetic products and has been quickly adopted to treat stress urinary incontinence in Europe over the recent years. It is injected into the tissue of the urethra using a light anesthetic. A cystoscope used during the procedure provides an internal view of the urethra and bladder, and helps with exact placement of the gel deposits. “Bulkamid® provides volume and acts like a scaffold for cells to grow through, supporting the closing function of the urethra for better control of urine with sudden increases in abdominal pressure,” notes Dr. Rogers. The clinical study of Bulkamid® treated 228 women at 33 medical centers and found that at 7 years, 80% of patients were cured of or had significant improvement of symptoms. Of the 70,000 women with stress urinary incontinence who have tried Bulkamid® over the past decade, there have been no reports of long-term complications, and very few reports of even minor or temporary complications like delayed emptying, painful urination, or urinary tract infections. Therefore, many women will choose this quick, safe and effective injection over surgical placement of a mid-urethral mesh sling. Dr Rogers was the first physician to deliver Bulkamid therapy in the state of California. Dr. Rogers is the only physician in the Santa Barbara area to offer these new treatments. She is also the only female urologist in the Santa Barbara area with fellowship training in female urology, received from Cedars Sinai Medical Center in Los Angeles. She graduated from Wake Forest University Medical School, and completed a urology residency and a general surgery internship at Mayo Clinic in Jacksonville, Florida. She treats a wide variety of urological issues in both men and women. For more information, contact the Sansum Clinic Urology Department, call 805-681-7564 or click here for more information about therapy options.