When you think of the many ways in which we work on and maintain good health, bladder health may not always come to mind. But good bladder health is critical in helping with eliminating waste from your body, preventing infections like UTIs, and supporting overall physical and mental well-being. Bladder health may not always be a comfortable topic to discuss, but our experts from Stony Brook Urology are here to talk about it!
The Experts
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 2:00 Bladder health and impact on quality of life
- 4:45 Misconception about aging and urinary issues
- 7:37 Common bladder issues among women
- 9:00 Overactive bladder v. Urinary tract infection (UTI)
- 10:15 When should a woman see a urologist?
- 11:40 Common bladder issues among men
- 13:10 Common myths/misconceptions about bladder health
- 16:55 What to expect when you make an appointment with a urologist
- 19:00 Surgical and non-surgical treatment options
- 25:38 Looking ahead: Innovations, clinical trials, and more
- 30:10 Talking about voiding issues with a provider
- 33:06 Closing Remarks
Full Podcast Transcript
00:00 Opening and Introductions
Announcer
Welcome to HEALTH Yeah!, where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Jason Kim, MD
Welcome to HEALTH Yeah! My name is Dr. Jason Kim, and I’m a Professor of Urology and Director of the Women’s Pelvic Health and Continence Center. I’m here today with my colleagues, Dr. Justina Tam and Dr. Steven Weissbart, who also specialize in treating conditions related to bladder health in both men and women. And we’re going to be talking today about bladder health.
Before we get started, I’d like to ask each of our experts to introduce themselves. Dr. Tam, let’s start with you.
Justina Tam, MD
Yes. I’m Justina Tam. I did my residence training here at Stony Brook as well as medical school. And then I went to Seattle and Virginia Mason to do my fellowship in female public medicine and reconstructive surgery. And now I came back to Stony Brook to join the faculty and with Dr. Kim here.
Jason Kim, MD
Alright, and Dr. Weissbart?
Steven Weissbart, MD
It’s great to be here with you this morning, Dr. Tam and also Dr. Kim. I’m from New York initially, and love being back here in New York. I was a resident at Mount Sinai Hospital in New York City. Before that, I was in Washington, DC, in medical school at George Washington University. And then I was at the University of Pennsylvania studying urogynecology and women’s pelvic health. Then joined the faculty here at Stony Brook in 2016.
2:00 Bladder Health and Impact on Quality of Life
Jason Kim, MD
Great, happy to have you both here. When you think of the many ways in which we work on and maintain good health, bladder health may not always come to mind, but good bladder health is critical in helping with eliminating waste from your body, preventing infections like UTIs, and supporting overall physical and mental well being.
Bladder health may not always be a comfortable topic to discuss, but we’re here to talk about it, and hopefully you will too. So let’s jump right in.
Okay, to start, why is bladder health something we should be paying more attention to? How common are urinary issues and why does it have such a big impact on the quality of life?
Justina Tam, MD
Yeah, it’s really important for our patients to be able to speak about it to their providers. It’s something that a lot of patients have a lot of embarrassment or are self conscious about and this is something they don’t even tend to bring up with people until somebody else asks them about it.
So we have patients who have, you know, urinary incontinence. They’re leaking, they’re trying to wear pads and trying to find ways, you know, their clothing is able to cover their pads so it’s not visible, and it’s really affecting their quality of life and their ability to do the things that they enjoy.
So I have patients who say, well, I can’t go and play pickleball anymore because now I’m leaking. I can’t go running, or if I run, I have to wear dark pants, so it covers everything. So it’s definitely something that’s really critical and really affects our patient’s quality of life.
Jason Kim, MD
Yeah, I mean, I find it oftentimes leads to social isolation and anxiety and depression. People stay at home. They don’t want to go out. They’re always worrying about leakage, right?
Steven Weissbart, MD
Yeah, I think you’re so right, Dr Kim. I think all of us see so many patients throughout the day and over the years who you know, come in reporting that somehow their bladder just isn’t working well. They’re either having urinary incontinence and involuntarily losing urine at times when it’s not socially the right time to use the bathroom.
Or another common expression that we always hear from our patients is they always are demanding a seat on the aisle because they’re concerned about going on an airplane or to a Broadway show. And so, you know, just having seen all the patients we’ve seen, it’s great to be here to share with everyone how important we all feel like the bladder is, and it’s really just such an important organ.
You know, all day long, our bladder has to fill with urine, and then it has to only when we want it to expel urine when it’s socially the right time to go. And so when that process doesn’t happen correctly, we really can understand how it could impact someone’s life and lead to a lot of impairment to their happiness.
Jason Kim, MD
Right, I think a lot of us don’t think about it, but we have some patients that go every 10 to 15 minutes, and can you imagine, you can’t live life that way, right? I mean, they know where the bathrooms are at all the stores and things like that.
Steven Weissbart, MD
Yeah, absolutely. And aside from just social happiness, I even have patients, I know you do too, Dr. Tam, where it really interferes with their occupation, whether it be a teacher who has some concern about being in front of their students, or even some of our own colleagues, you know, who might feel that they can’t get to the bathroom quick enough when they’re with patients.
Jason Kim, MD
Yeah, it’s interesting you bring that up. I always ask patients what they do for a living, and we find a lot of dysfunction in teachers and nurses, because they’re the professions where they don’t have time to necessarily go to the bathroom, or they can’t because they’re taking care of kids. So bladder health can affect you in every way.
4:45 Misconception About Aging and Urinary Issues
Do you find that many people think urinary problems are just a normal part of aging and therefore don’t seek help?
Justina Tam, MD
Yeah, absolutely. I have many patients who come into the office and they say, you know, I had no idea this was something I could even take care of. I was always told, Oh, you know, this is just a normal part of aging, and this is just what happens, and you just have to deal with it. And then when they’re with friends or something, and their friend says, Oh, well, actually, I saw somebody and they gave me, you know, a medication, or I had a procedure done. And then they start to kind of open up this conversation that lets them know that this is something that they’re just kind of suffering through silently, and that there’s many, many people out there who have the same exact issues, and that there’s treatment options available.
And of course, there’s things like help with physical therapy, you know, less invasive things, there’s medications, there’s even procedures, you know, of course, depending on what the issue is. But there’s just so many options that are out there and available that patients don’t know about, or are just kind of told that this is something they have to deal with.
Steven Weissbart, MD
Yeah, that’s definitely one of the most frustrating things I hear about, you know, from patients when you know they’ve shared with me that they haven’t sought medical care just because they thought that they were incontinent, you know, the involuntary loss of urine or their urinary frequency was just part of normal aging. And there’s so many, you know, wonderful ways that we could help patients, irrespective of their age. So when I hear patients, you know, and they share with me that they didn’t seek medical care just because of their age, it’s just so frustrating, because there’s so many great ways that we could help.
Jason Kim, MD
Yeah, it’s interesting because everyone assumes it’s a part of aging and I do think older patients tend to have more bladder symptoms, but it doesn’t necessarily mean it’s normal. And as we’ll get into in a little bit, we’ll talk about some of the great treatment options we have.
Justina Tam, MD
Yeah, and to get back to what you’re saying about age, we have lots of people who are younger with, you know, very similar issues as well. So it’s not just about older patients, the younger patients have the same issues and these should also get treated.
Jason Kim, MD
Oh, Dr. Tam, that’s a great point. You know, I get patients that are 18, 19, 20, and they’re saying, why is this happening to me? I think only old people get this, and we have to counsel them on that. No, this is very common.
I mean, I would estimate probably, like 25 to maybe 30 percent of all adults have some sort of bladder issue. Would you agree with that?
Steven Weissbart, MD
Absolutely. I think the data really supports that. If you look at, you know, studies that report on urinary symptoms and bladder pathology across the world, I’ve seen studies really reference 20, 25 percent of individuals across all ages, you know, will have some difficulty with their bladder, whether that’s going too frequently, with too much of an urge to have to rush to the bathroom or even involuntarily losing urine.
Jason Kim, MD
Yeah. I think it’s very important for patients to know this is extremely common, much more common than you think. We get a lot of patients that come in saying, why is it only me, and part of our job is to let them know, you’re not weird, you’re not strange, this is very common.
7:37 Common Bladder Issues Among Women
All right. Dr. Tam, let’s talk about women first. What are some of the most common bladder or voiding issues you see? Things like leakage, overactive bladder, pelvic organ prolapse. Can you just give a quick rundown?
Justina Tam, MD
Actually, a lot of things you’ve already kind of started to talk about. So probably urinary incontinence is one of the more common things that people come in with. So meaning involuntary leakage of urine, meaning they can’t get to the bathroom in time or the urine is coming out at a time that you don’t want it to be coming out, or urinary frequency, where they’re running to the bathroom all the time.
You know, they’re focused on where the bathroom is, any place that they go, and always thinking about, okay, well, I should probably pee in the next like hour or so, so I gotta, you know, make sure I’m sitting in the aisle or something like that, on a plane or in a movie theater, for example. Same sort of thing. Things like urinary incontinence, urinary frequency, things like pelvic organ prolapse, are also very common.
You know, we talk about people who have had pregnancies or deliveries, they’re more likely to have things like pelvic organ prolapse, which is when you have a bulge of tissues from the vaginal canal. And yes, it happens a lot more commonly in women who have had children. But of course, people who haven’t had children may also have the same sort of issues. And yes, it’s common to have something like this, but you know, there are people here like Dr. Kim, Dr. Weissbart and myself, who are here ready to help people who have these issues.
9:00 Overactive Bladder v. Urinary Tract Infection (UTI)
Jason Kim, MD
I think another big one might be urinary tract infections, right? And I think we’ve all seen this, we get patients who are told they have UTIs when it’s actually overactive bladder, and they’re put on multiple courses of antibiotics, and don’t get better, and it doesn’t make the overactive bladder better, and it creates problems for UTIs down the line due to antibiotic resistance and things, right?
Steven Weissbart, MD
Yeah, that’s such a wonderful point, Dr. Kim. I mean, recently, you know, I was just reading a study referencing how common antibiotic resistance is owing to the fact that patients have used so many antibiotics and have just been cycled, you know, every month or every other month on a different antibiotic, and their underlying, you know, pathology, the underlying problem with their bladder or their urinary tract wasn’t identified.
So I see patients very, very frequently who come in who have been on, you know, five or 10 antibiotics in the past year. And it’s really, really just terrific to make a diagnosis of either a kidney stone or a prolapsed bladder and then find out, you know, what really was the etiology of their symptoms and get them off all those antibiotics.
Jason Kim, MD
Yeah. I mean, I see a lot of patients frustrated. They keep going to urgent care and they keep giving antibiotics when they have negative urine cultures, and they come to us, and maybe we talk about behavioral modification or start a medication for urine leakage or overactive bladder, and they get better right away.
10:15 When Should a Woman See a Urologist?
What are some signs or symptoms that women should not ignore? The things that really prompt a visit to your urologist or pelvic health specialist?
Justina Tam, MD
I would definitely say things like pain for sure, bleeding, blood in the urine are all things that you should definitely see a urologist for. Issues that we worry about, you know, that are more scary, things like malignancies and tumors. So you definitely want to make sure you see a urologist sooner rather than later.
And for people who are getting, you know, urinary tract infections very frequently, if they’re having pain all the time, we want to really kind of hone in on the symptoms, maybe even do an exam, really get an idea of what’s actually going on, to kind of solve the underlying issue, like we were talking about.
Steven Weissbart, MD
I get asked that question all the time from family and friends and, you know, my advice is, when in doubt, you know, get it checked out. You know, even if it’s just a single visit, just to identify the problem and just the assurance of knowing there’s nothing serious, I think that can go a long way for patients.
I’ve seen patients who come in, you know, frantically concerned about a specific problem, and, you know, doing an exam or doing some basic testing just gives, you know, me as the clinician, and of course the patient, a ton of reassurance to know what’s going on.
And most of the problems that we see are actually elective in treatment, and that way, a patient could decide on their timeline when it might be the time for treatment. But I think just identifying the problem and making an accurate diagnosis is important because there can be sometimes things that get missed in the urinary tract.
Jason Kim, MD
Okay, great points.
11:40 Common Bladder Issues Among Men
Dr. Weissbart, let’s turn to men. What are the most frequent urinary issues you see, especially as men get older?
Steven Weissbart, MD
Yeah, so we see a very large number of male patients who also have bladder difficulties. The big problems that we see in our office are urinary symptoms ranging from urinary urgency, the strong, compelling desire to go to the bathroom, which is difficult to postpone. Nocturia, which is the experience of having to wake up very frequently throughout the night to use the bathroom. You know, unfortunately, we see men who even have such severe bladder problems where they have catheters for urinary retention, where they can’t even eliminate any urine without the need of a catheter.
And so we see patients, as they age, unfortunately, start to have a real increase in the urinary symptoms that I just mentioned.
Jason Kim, MD
Right. And men also, too, can have a lot of the same symptoms as women, overactive bladder, urinary leakage, urinary tract infections and things like blood in the urine.
Steven Weissbart, MD
Yeah, absolutely. It’s funny when I’m out with family and friends, and you know, they share with me that they might have a bladder problem. They oftentimes even ascribe it to their prostate. But I think your point, you know that male urinary symptoms may not actually even originate, you know, with any prostatic problem, it could actually be their bladder itself that’s the cause of the problem. And men, just like women, can get overactive bladder and have bladder problems as well, independent of the prostate.
Jason Kim, MD
I think that’s why it’s important to see experts like ourselves to differentiate these issues. Because like we’ve been mentioning, we have a lot of effective treatments.
13:10 Common Myths/Misconceptions About Bladder Health
Okay, across both men and women, what are some of the biggest myths and misconceptions you hear from patients? I know we’ve touched on some of it, but why don’t you guys tell me about a few more that you might think of.
Steven Weissbart, MD
Yeah, absolutely. So I think the first myth is that, you know, my urinary symptoms are just part of normal aging. Again, that just is something that’s just so frustrating because we see so many patients who are in their 60s, 70s, 80s and even 90s, who are improved with treatment.
The other myth is that when I share, you know, with a physician or a clinician, you know my bladder symptoms, I might feel embarrassed and feel like it’s difficult to share with my clinician what’s actually happening to my bladder. You know we have such a wonderful pelvic health center where patients, you know, come to get individualized care and personalized treatment. And I think they could really, you know, feel comfortable being in that environment and speak openly about what’s going on with their bladder and how it’s affecting their quality of life.
Justina Tam, MD
Yeah, that’s a great point, Steve. I feel like a lot of patients do come in and they say, oh, you know, this is really embarrassing, but for us, we say, well, no, actually, I’m just gonna ask you directly, you know, do you have these urinary symptoms? And as soon as you kind of open that box, I think a lot of patients realize, hey, this is actually something that is common, and a lot of people have it. Because here’s my doctor asking me directly about it, because so many of my patients, you know, my patients, have these sort of issues.
Jason Kim, MD
Yeah, you know, it’s amazing. I get patients in thinking they’re strange because they have these problems, and I spend a lot of time counseling them, telling them, you’re probably the 20th patient I’ve seen today with these issues.
And when we even start talking about treatments or diagnosis and treatments, I’ve had patients leave my office crying because they had a sense of hopelessness. And even though we haven’t started treatment yet, just knowing that there’s something there, it really makes them feel much, much better, and once we validate their concerns.
Steven Weissbart, MD
Yeah, and I think also just for them to realize they’re not alone and that there are other patients out there who, A. Have the same problem and B. Who have been successfully treated, I think makes them just feel this great sense of hope. And it’s really fun working with those patients and getting them to the finish line.
Justina Tam, MD
Yeah, there’s just so many different treatment options that are available to them that I think it’s really, it gives them a lot of hope, because they know that, you know, I don’t just have to have surgery. Surgery is not my only option. You know, I don’t have to just take a medication. There are non-medication, non-surgical treatments as well that they can do.
Jason Kim, MD
Do you find that patients wait too long to get help?
Justina Tam, MD
Oh, absolutely. All the time. They’ll come in and they say, oh, how long has this been going on? Well, you know, since I had my children, and their children are like 30 years old, you know, and they haven’t gone to see anybody because they’ve been taking care of their kids, or they’ve been taking care of their parents. And they think that this is something that’s a normal part of aging and they just have to deal with it.
Jason Kim, MD
A lot of times you’ll treat them and they’re better. And they say, oh my God, I should have had this done 30 years ago. We see that all the time.
Steven Weissbart, MD
Yeah, it’s so funny you mentioned that. I’ve always wondered, you know, why patients sometimes wait long. I wonder, you know, sometimes, is it perhaps a you know, perceived idea that once they seek treatment, it automatically translates into a surgical treatment option, which is, you know, just not the case.
You know, we see so many patients who could be adequately treated, either with basic pelvic floor physical therapy, or with very small amounts of medical treatments or even some office injections. And they really have such a wonderful, wonderful improvement to their quality of life for those basic treatments that I always wonder why patients don’t come in sooner to get treated and evaluated.
Justina Tam, MD
I feel like sometimes even just basic things, like, you know, dietary modifications or not even medications, things that they can do on their own very easily, that they don’t even think about, can be really helpful.
16:55 What to Expect When You Make an Appointment With a Urologist
Jason Kim, MD
Right, so let’s talk about a patient who comes to the office. What kind of evaluation would you do? What kind of testing would you want to do?
Justina Tam, MD
Yeah, I think it really depends on what their symptoms are and what their main question and goals are. So if they come in and they say, you know, if they have urinary tract infections, often we’ll start off with what their urinary symptoms are, are they having pain? Are they seeing blood in the urine? If it’s about leaking or involuntary loss of urine, when is this happening? How often is it happening? So we’ll ask more questions, what their symptoms are like, how it’s affecting their quality of life.
And then in terms of testing, sometimes we do urine tests to assess for urinary tract infection, to assess for blood in the urine. We may do some imaging, like ultrasound of the kidney or the bladder to see their bladder properly. And then other times, we will do other things to assess the function of the bladder, like a urodynamics test, which is a special kind of functional test to help us assess the bladder and the urethra and the pelvic floor muscles, to make sure that those things are all kind of working, you know, concurrently, to help them empty the bladder to hold the urine in the appropriate setting for them.
Steven Weissbart, MD
Yeah. And I think one part of that I really, really enjoy is just getting to know the patient. And I, you know, I think especially what we do, it’s really not a one size fits all model, and each patient needs to receive individualized care, and then decide based on, you know, how their bladder problem is affecting them, how best to treat them.
So I really enjoyed just getting to know our patients, and really learning from them. You know how you know their bladder problem affects them individually.
Jason Kim, MD
I think one important takeaway for our patients they may not realize is they may think they’re going to come and get testing and just get surgery, but a lot of times, just speaking to the patient and getting the basic history is enough. We can start treatment because we were able to differentiate between these different conditions.
Steven Weissbart, MD
Yeah, and sometimes patients come in not necessarily even needing treatment. Sometimes I’ve had patients who just want an explanation for why their bladder isn’t the same as it used to be. And just that knowledge, you know, for patients can be very important for them.
19:00 Surgical and Non-Surgical Treatment Options
Jason Kim, MD
Right. So, you know, we’ve touched base on some treatment options for these conditions. Can you guys run through the treatments for these conditions, other than, you know, we talked about a little bit about behavioral modification, physical therapy, but maybe we’ll talk about overactive bladder first. Can one of you tell me kind of the range of treatment options?
Steven Weissbart, MD
Yeah, and that’s one of the reasons I really love working at Stony Brook, and specifically our Pelvic Health Center, is that we really have every single treatment modality available to help our patients.
So for overactive bladder, and again, that’s where women have a very strong, compelling desire to go all the time. They may go frequently, wake up at night or leak urine. Treatment for that, as Dr. Tam mentioned, can, you know, start with behavioral therapy and pelvic floor physical therapy, medical treatments, and there are actually a large number of medical treatment options now available to us, you know, in this day of medicine.
And then for patients who are intolerant of those medications or just may not feel it’s the right fit for them, there actually are therapies where we could either inject medication into their bladder and deposit medication into the bladder. One is Botox. And then also neuromodulation, which is where we could use a variety of different techniques to stimulate some nerves that help control the bladder.
Jason Kim, MD
Yeah, I think, yeah, as Dr. Weissbart mentioned, we offer all these therapies. There was a recent study from NYU that showed that – well, first of all, for overactive bladder, the compliance rate of medications at one year is only 30 percent due to side effects, cost, lack of efficacy. We have about four or five different procedural options, and many patients don’t know about these options. A recent paper from NYU, should only 3 percent of patients with overactive bladder go to these therapies.
I know it frustrates all of us because we think more patients should get on to these therapies. We do a lot of these therapies, and I think it improves the patient’s quality of life. I mean, it’s not unusual, I see this all the time, you guys must see patients who have been cycled on medication for 20, 30 years, and it doesn’t work, and they get a sense of hopelessness, and they kind of give up. Have you seen that?
Steven Weissbart, MD
Absolutely, and especially in today’s time in medicine, where there are just so many advances, you know, there are so many new treatments coming out for overactive bladder. And it says, as I mentioned, just great to be at the Pelvic Health Center where we offer all of these newer therapies. The new one that actually just came out, I know, Dr. Kim and Dr. Tam, we’ve discussed this a whole bunch of times, is actually tibial nerve stimulation and even being able to implant a small little device about the size of a nickel, right by one of the nerves by the leg region that helps to control the bladder. And so that’s something that has been really, really exciting in the past year to be able to offer yet another therapy to patients who have overactive bladder.
Justina Tam, MD
Yeah, and I want to kind of tie back to when we mentioned misconceptions, you know, treatment options, you know, don’t always include just surgery.
And when we talk about, you know, more procedural types of interventions, there’s a range in terms of how invasive things are. Some things are, you know, procedures, but they’re not requiring incisions and things like that. So for example, we’ll do, you know, percutaneous tibial neuromodulation, which is sort of like an electro acupuncture type of therapy, so it’s not super invasive. There’s no incisions and things involved.
We talked about, you know, bladder Botox injections, which, you know, requires us to put a small camera that goes inside the bladder to inject medication. So there’s no incisions involved, and they’re, you know, a lot more invasive than when we talk about things like, you know, implantable devices.
And I feel like a lot of patients come in thinking, oh, if I come in and I can’t do medications, I don’t want to do surgery, not realizing that surgery isn’t surgery.
Jason Kim, MD
A lot of them are office based procedures without anesthesia. So the patient can come in, they can drive themselves there and drive themselves home. Yeah, that’s a great point.
Steven Weissbart, MD
Yeah, that’s really amazing. You think about the impact that these therapies can make in someone’s life, and yet at the same time, they could be out to dinner that night with family and friends without really any post operative restrictions.
Jason Kim, MD
Dr. Tam, why don’t you tell us briefly about treatment options for stress urinary incontinence, which is leakage with coughing, laughing, sneezing and exercise.
Justina Tam, MD
Yeah. For stress urinary incontinence, I always tell patients, there’s a wide range of things we can do. There’s less invasive things like pelvic floor physical therapy has been mentioned a number of times to help kind of strengthen those pelvic floor muscles so that they can help prevent leakage of urine.
There’s also things like incontinence pessaries, which is a device you can put inside the vagina, kind of push up against the urethra to help prevent leakage of urine. And then, of course, there’s surgical procedures as well, like, for example, urethral bulking agents, which is where we actually take a small chemical going into the urethra, and we inject an agent to help the urethra to close together better, to prevent leakage of urine, which is absolutely an office-based procedure.
I have patients who come in and they say, well, like, how long to have to be off my feet? Do I have to, you know, not lift up my children, for example. And I say, no, you come in, you do the procedure, you go home, and do whatever you want afterwards.
Jason Kim, MD
I tell patients, they could do it on the lunch break and go back to work.
Justina Tam, MD
Yep. And then if something like that isn’t working out for them, or if they want something that may be a little bit more durable, for example, we’ll talk about things like slings, which is where we put a small piece of mesh underneath the urethra to support the urethra to help prevent leakage of urine. That one does require a little bit more downtime, but we have many, many patients that have such great success with it.
Jason Kim, MD
Yeah, slings, I think overall, offer over a 90 percent chance of very significant improvement in their therapy.
Dr Weissbart, can you just touch briefly on maybe some treatments for enlarged prostate?
Steven Weissbart, MD
Yeah, so actually, it is a very, very important question because there are so many different treatment options available to us now as urologists for prostatic enlargement, and those treatments are mostly outpatient, done with a camera where we laser the enlarged prostatic tissue or use different modalities such as steam to destroy the tissue and remove the tissue that should not be obstructing the urinary tract.
These therapies oftentimes are done in the outpatient surgical center, where patients don’t need to spend the night at all. And some therapies are even offered in the office. For patients that might have more severe cases, we even are now using robotic surgery to remove part of the obstructing prostate tissue.
Jason Kim, MD
So that’s a minimally invasive surgery through a few small holes.
Steven Weissbart, MD
Absolutely. And you know what’s really, really terrific about these therapies, even though they’re extremely efficacious and they work extremely well, they don’t require the typical, you know, old fashioned two weeks in the hospital and catheters for a long period of time. Most of the time, these therapies are outpatient with a very small duration of need for a bladder catheter.
25:38 Looking Ahead: Innovations, Clinical Trials and More
Jason Kim, MD
What’s new and exciting in the world of bladder health? Are there innovations or technologies that you’re especially excited about?
Steven Weissbart, MD
Yeah, I mean, I’m excited about the overactive bladder therapies, just because of how significant overactive bladder is to the world’s population.
You know, having the need to know where every bathroom is, having the need to perhaps carry some pads with you because you’re concerned about leaking and having to eliminate things that you truly love because you’re afraid that your bladder may not cooperate with you at the right time, it’s such a significant problem to patients and so that’s why it’s just so exciting to be a urogynecologist at this time, to be able to treat women who have overactive bladder and also to treat men who have overactive bladder, and be able to use new techniques such as neurostimulation to help control patients’ bladders.
In the past, patients would need quite extensive surgery in the 1970s, the 1980s, you know, you read about patients who even had, you know, some of you know their intestines used to enlarge their bladder. You hear about therapies that just are not the therapies today, which are just so terrifically minimally invasive.
Whereas I mentioned, patients are now treated in the office, and they can go back to work, you know, typically that day, or go out to dinner with their family friends.
Jason Kim, MD
I mean, yeah, I share your excitement. So, you know, a good example of this are the implantable tibial nerve stimulators. We talked a little bit about this kind of electro acupuncture in the ankle, and the tibial nerve has been found in the ankle. It sounds crazy, but stimulation of that nerve is found to help control urinary leakage. And I think this is a hot new target.
Currently, there’s three FDA approved devices for this target, and three years ago, there were none, and there’s more to come.
And, you know, I think it’s nice because at Stony Brook, you know, we’re part of clinical trials, and we were a big part of one of the clinical trials for just a newly FDA approved device. So I think it’s nice. We like being part of these trials because we get early access to these devices that are able to better help our patients.
Dr. Tam, is there anything else you’re excited about?
Justina Tam, MD
Yes, I also wanted to bring up, you know, there’s a new kind of evaluation that we were able to do to assess our patients. So we talked about, you know, things like urodynamic testing, which requires us to place some catheters into the bladder and abdominal pressure sensors, and they might be a little bit more invasive in the office, and sometimes, you know, they take a long time, a little more uncomfortable.
So now we have what we call this ambulatory urodynamics, just a small device we’re actually able to put inside the bladder very easily. And patients are able to kind of go about and live their lives for a little while, and kind of let the testing kind of assess their bladder while they’re out doing their normal things.
So it’s a lot less invasive for them. It’s a lot more comfortable, I feel like, so I think it’s really great that we have this option here at Stony Brook.
Steven Weissbart, MD
And I think one thing also that I really want to emphasize, especially Dr. Tam and Dr. Kim, for our patients who have bladder prolapse, which is again, where the bladder is no longer in the proper position and it’s herniating out of place, is how frequently we’re using the robot now for treating those women who have bladder prolapse, and how specialized that surgical treatment is.
Jason Kim, MD
I think I just want to get back to Dr. Tam’s point a minute about this bladder monitoring device.
Traditionally, in the office, we had to have a big machine and a lot of staff. It was very resource intensive with staff and room needs, and as a result, we could only perform that in two of our nine offices.
With this new urodynamics monitoring, we’re able to bring it to all our offices, and so we’re already offering it in our satellite locations, such as Greenport. You know, before, patients had to drive over an hour to get to our main offices in a traditional kind of hub and spoke model.
But I think it’s great for patients, it’s great for the system, it’s great for the physician. So everyone benefits from this kind of technology. So I’m excited that we offer a lot of these things.
Steven Weissbart, MD
Yeah, and I think that also ties in, Dr. Kim, to the question before about why do patients wait so long to get treatment. Obviously, everyone’s very busy. People are working. There might be some, you know, new parents out there, and it might be hard for patients to make the time to seek care for their bladder. And so now that we have ambulatory urodynamics in all these locations, and I think we also have specialists and colleagues that we all love working with in all these locations, really makes bladder care just so much more accessible for patients so they don’t have to wait as long.
30:10 Talking About Voiding Issues With a Provider
Jason Kim, MD
Okay, so for some people watching this who are embarrassed or hesitant to bring up these issues with their doctor, what would you say to them?
Steven Weissbart, MD
I would just, you know, give it a try. You’d be surprised how rewarding it could be to make that phone call, come in, get assessed and just have a chance to, you know, spend, you know, 30 minutes, 60 minutes, with someone who’s really, really experienced on the topic, and really knows how to treat problems that are so common and yet so undertreated and can have such an effect on quality of life.
So I would say, go into the experience with an open mind, just try to make the appointment simply to learn about what are the treatment options. And then, you know, working with your clinician to find a perfect plan. And I have patients where they come in and you know, they decide not to seek any treatment, but yet, just knowing that treatment exists, it still gives them some peace of mind, and it is just so much more rewarding for them to know that there are options for them.
And maybe when it’s the right time for them, you know, they’ll go ahead and pursue a treatment. It wouldn’t be uncommon for a patient to come in, I meet them, get to know them, and then they decide that’s just not the right time for them to be treated. And then years later, you know, life changes, and they decide to proceed with treatment.
And I think having met me, you know, years ago, and just having the opportunity to let that information marinate in their mind could be very helpful for them.
Justina Tam, MD
I was gonna say patients know they’re not alone. You know, these are things that lots of patients have issues with, and this is something that we actually have people who specialize in dealing with, right? So, and like you had said, Dr. Weissbart, you know, when in doubt, check it out, right?
So if there’s a problem and you’re not quite sure, come see one of us. We’re happy to talk to you. You don’t have to have surgery. And there’s so, so many different options you can go with, just showing up in the office doesn’t mean that you’re saying I want surgery. Now, that’s not the only thing that’s available.
Jason Kim, MD
I also want to stress, you know, although we’re the experts in voiding dysfunction, Stony Brook Urology has 17 urologists in Suffolk County, and for the most part, they can deal with the vast majority of these issues. And if it’s something more advanced or complicated, then they can refer to us.
So even if we’re not at the location closest to where you live or it’s most convenient to go, I would encourage patients to visit one of our physicians and they can point you in the right direction.
Steven Weissbart, MD
Yeah, I really, really love working at Stony Brook, and it’s just been so special meeting all of our colleagues and partners who are just experts in urology, and even though the Pelvic Health Center is located now in Setauket, we have so many experts, even outside of Setauket, who are knowledgeable about this topic, and who could, of course, refer patients to the Pelvic Health Center if they need any more specialized or individualized care.
33:06 Closing Remarks
Jason Kim, MD
Great. Thank you.
Thank you all for sharing your expertise today. The bottom line is this, bladder problems are incredibly common, but they are not inevitable. And help is available. If you or someone you love is struggling with urinary symptoms, talk to your healthcare provider or reach out to the bladder health specialists here at Stony Brook Urology. We have nine offices throughout Suffolk County and multiple experts who can help.
And if you found this conversation interesting or informative, please like and subscribe for more content just like this.
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