Drs. Jason Kim and Steven Weissbart of the Women’s Pelvic Health and Continence Center at Stony Brook University Hospital have successfully performed one of the nation’s first — and the East Coast’s very first — Glean™ Urodynamics procedures using Bright Uro’s ambulatory urodynamic system.
In this episode, Dr. Jason Kim discusses what exactly bladder dysfunction and urodynamics are, as well as innovations happening right here at Stony Brook Medicine to improve efficiency, accuracy and the overall patient experience.
The Expert
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 1:38 What is bladder/voiding dysfunction and how common is it?
- 3:30 Traditional and Glean Urodynamics
- 6:18 Gleaning device
- 9:48 Expansion of urodynamics at Stony Brook Medicine
- 10:38 Clinical trials and the benefit of an academic medical center
- 13:50 The benefit of a gleaning device on the patient experience
- 14:20 Data collection and personalized patient care
- 15:38 Evaluation and urodynamics testing
- 16:07 Dr. Kim’s interest in the field of urology
- 17:10 The future of urology and urodynamics
- 17:42 Closing Remarks
Full Transcript
00:00 Opening and Introductions
Announcer
Welcome to Healthcast, where leaders and experts from Stony Brook Medicine come together to discuss a range of topics, from leadership and strategic planning to patient care and the inner workings of a successful healthcare system.
Timothy Brown
Hello and welcome to Healthcast. Dr. Jason Kim of the Women’s Pelvic Health Incontinence Center at Stony Brook University Hospital has successfully performed one of the nation’s first and the East Coast’s very first Glean urodynamics procedure using Bright Uro’s ambulatory urodynamic system.
This is a significant advancement in the evaluation of bladder function for the estimated 17 million people who experience daily bladder control problems in the United States today. We’re lucky enough to have Dr. Jason Kim here joining us, and before we jump into talking about what this means to people and patients all over the country, particularly here on Long Island, Dr. Kim, if you will, just introduce yourself to our audience and tell us a little bit about what you do here at Stony Brook.
Jason Kim, MD
Sure, okay. My name is Jason Kim. I’m a Professor of Urology, also the Director of the Women’s Pelvic Health Incontinence Center. Our center is a little bit unique. It’s a multidisciplinary center with both your gynecologist, from a urology background and gynecology background, and colorectal surgery in a dedicated physical space. This actually makes our facility quite unique compared to most other places, as most centers are virtual. So we provide high quality care to patients with voiding dysfunction.
1:38 What Is Bladder/Voiding Dysfunction and How Common Is It?
Timothy Brown
So let’s just start off with kind of a level set for everyone. What is bladder dysfunction and how common is that for folks?
Jason Kim, MD
Yeah, it’s a great question. Well, first of all, bladder dysfunction, or voiding dysfunction, is very prevalent. It’s hard to pinpoint the exact number, but probably 20 to 25 percent of Americans experience some sort of voiding dysfunction, and it increases significantly with age.
And examples of voiding dysfunction are overactive bladder, where you get urinary urgency and you feel like you have to go the bathroom a lot. I have some patients that have to urinate every 15 minutes. And as you can imagine, that’s extremely disabling. When you go out traveling, you worry about the bathroom.
There there are patients who leak urine. And there’s different types of urinary leakage, and this is where a test like urodynamics is important.
So there’s stress urinary incontinence, which is leakage with coughing, lapping, sneezing and exercise. There’s urgency incontinence, which is “I got to go, I can’t keep the bathroom in time.” And there’s overflow incontinence. And in men, as they age, one problem that arises is enlarged prostate, which can cause a combination of these symptoms.
So urodynamics is a vital test to help us distinguish the different types and tailor a treatment plan.
Timothy Brown
Yeah, I imagine it’s it probably almost has to be debilitating for some folks, you know, they feel like they would have to be near a bathroom at all times, and that’s difficult if you’re leaving the home.
Jason Kim, MD
Yeah, it’s extremely disabling. And in fact, we find that a lot of times it affects patients activities of daily living, their social life. Some patients won’t go out because they have to go to the bathroom a lot.
In the older population, we hear “I go to Florida for the winter, and I know where every bathroom is at every rest stop and every restaurant on the way down.” Or people worry about travel. Or I often ask patients, do you know where the bathrooms are at stores? You know? And they they can tell me exactly where they are and so you know, it’s really riding on their mind at at all times.
3:30 Traditional and Glean Urodynamics
Timothy Brown
So in the introduction I mentioned Glean. What exactly is Glean?
Jason Kim, MD
Glean is a new type of urodynamic system. And before I talk about Glean, let me just mention traditional urodynamics.
So traditional uroynamics has been a mainstay of testing for voiding dysfunction for probably the past 40 years or so, or even longer, and there’s been very little technological innovation in this procedure over that time.
Typically, how it’s performed is in our office. We have a dedicated urodynamic suite, which is a room larger than a regular exam room. We have a computerized machine and a special chair, and the patient had to sit in this chair, we put a catheter into the urethra, into the bladder and usually one into the rectum or vagina. The computer then will fill the bladder with fluid. And when we ask questions like, “tell us when you first feel like you would have to go the bathroom,” “tells us when you have to go,” “tell us when you have to drop everything and run.” And we can measure pressures generating in the bladder, how much you can put in, the flow rate and things like that.
As you can imagine, this test can be quite uncomfortable and cause patients a lot of anxiety, because we’re putting these catheters in them and actually watching them urinate into the special chair contraption in front of everyone, and oftentimes, especially people have what we call a shy bladder, they may not be able to urinate on command, and it limits usefulness of this test.
Additionally, the filling. It’s just a snapshot in urodynamics. Usually we fill for about 10 or 15 minutes, and this may not reflect what we call a physiologic fill. It’s more like a force fill, so it may not accurately reflect what is truly happening in the patient.
For example, we’re doing it in the office and a lot of patients have nighttime symptoms, and this is not replicating those symptoms.
6:18 Gleaning Device
So this Glean system was designed with that in mind to overcome some of these barriers. In addition, urodynamics is a very resource-intensive procedure. We need the dedicated suite. There’s a high capital cost of the machine. You know, our machines cost over $100,000, they probably last five to seven years. We need dedicated staff that’s specially trained for urodynamics. At Stony Brook, we have probably one full time nurse who does this and a nurse who does this part time. We have seven locations because of this high resource-intensive nature of urodynamics, we can only offer urodynamics right now two of our seven sites.
So as I mentioned, we overcame some of these barriers. And if you can see this picture, it’ll show what our urodynamics room setup looks like. But what I want to show you is a Gleaning device. I actually have one here. So the picture will show it’s a whole room that we need to do urodynamics. This device that fits in the palm of my hand is basically taking over regular urodynamics.
This device is deployed into the bladder, and it’s left there. And it can actually be left in the bladder for a few hours while they’re in the office. They could sit in the waiting room. They could go out and run errands. Or one of the most powerful things is we can do it in the afternoon, send them home at night and determine what’s happening at night.
Now, there’s a few things. With this device, it’s not predicated on us force-filling the bladder and trying to get an artificial idea of what’s happening. Their bladder is filling naturally, and we can see what happens in real time after that. Once it’s placed, they return to the office either a few hours later or the next day, and we pull it out through the string, so the string hangs out of the urethra, and we download the data via Bluetooth to a physician app on an iPad, and we generate the information.
Timothy Brown
So it’s just actually recorded on the device.
Jason Kim, MD
Yes, this is actually a pressure sensor, and it’s interesting because some people said, “well don’t patients feel this.” In previous studies they’ve tested this compared to conventional urodynamics, and patients are not really bothered by this.
Timothy Brown
Tremendous difference. So why is the evaluation so critical?
Jason Kim, MD
Well, number one, sometimes patients, when we talk, we don’t always get a clear story of their urinary leakage or their voiding dysfunction. You know, to me, one good example is patients come in and say, I have trouble emptying, yet they also have symptoms of overactive bladder, and sometimes when they can’t urinate, it’s actually because their bladder is spasming when it’s empty, making them feel like they have to go urinate.
However, I need to differentiate whether they’re actually not urinating or whether there’s bladder spasm too often. Another classic example is in the patient men with large prostates. Oftentimes, we’ll do a surgery to open up the prostate to allow for better voiding function, but we need to make sure that the bladder is still working, able to contract beforehand and that’s one of the times that we do a lot of urodynamics, and this will help us answer that question.
Timothy Brown
So how did you come to be involved in all of this? It’s a fascinating piece of information.
Jason Kim, MD
So part of what I do is, I’m one main physicians at Stony Brook who does urodynamics, and we recognize that this is an uncomfortable test. It takes up a lot of resources, and we’re always looking for the better thing.
In fact, in the past, I’ve been asked at our national meetings to give debates whether urodynamics is necessary for some of these tests. And honestly, the answer had been that we sometimes avoid it due to patient comfort and anxiety. Anecdotally, when I talk to my colleagues, there’s a high cancelation rate in urodynamics because patients are afraid of it. And when I heard about this technology, I actually sought the company out because I thought it would be a game changer.
I actually think it’s going to be a paradigm shifting device, and based on my experience, and I was lucky enough for them to include me in the clinical trial, and from my experience there I really did realize this is going to be a game changer. So now that it’s FDA approved, I wanted to get it out there as soon as possible.
9:48 Expansion of Urodynamics at Stony Brook Medicine
And I think the power of Glean, we’re already seeing the power of Glean. We, of course, we scaled up. This was only FDA approved in April. We started at our main site. We’ll do most of urodynamics, but we’re already expanding to locations, traditionally, where we didn’t do urodynamics, which is the power you know, I think we’re going to soon expand to Riverhead, where we didn’t have the office space to do it.
I think another good example is we plan to bring this also out to Greenport. We have a very small satellite office there. We don’t have the resources to do traditional urodynamics, and it’s a very elderly population, it tends to be, and so a lot of them don’t want to travel over here to do the test. So I think it’s the best case scenario for patients, for the practice and for the system.
10:38 Clinical Trials and the Benefit of an Academic Medical Center
Timothy Brown
You mentioned clinical trials and I always think that’s an interesting aspect – any clinical trials that happened here at Stony Brook that we’re part of and I think that’s part of the benefit of an academic medical center. Can you talk a little bit about that?
Jason Kim, MD
Sure, I love being on the cutting edge and being able to offer my patients the best in therapies. I’m one that I always look at all new technologies, and if they make sense and the data is there, I like to implement them very quickly because I think it better serves our patient population.
It’s great to be part of something like this, you know, to work with a company and a device that really will benefit everyone involved. So I’m always looking for clinical trials.
Timothy Brown
So what were the outcomes of those?
Jason Kim, MD
So the clinical trial was recently published in the Journal of Endourology, and the study was called Modern Urodynamic System Efficacy. And what we were doing was we were comparing the new Glean system to traditional urodynamics. So patients would get traditional urodynamics first, and then we would deploy the Glean device and leave it in for a few hours. We wanted to look at the feasibility of using this device.
And so what we found was that we were able to successfully insert it in 97 percent of patients with ease, the average time to insertion was about 30 seconds, and the average time of removal after the test was over was about five seconds. So it was easy to do.
We want to look at the safety profile. And there were some minor adverse outcomes, but nothing that really affected patients significantly, and nothing comparable to traditional urodynamics, very transient self limiting adverse effects, such as dysuria, burning with urination, which we would expect anytime we put a catheter in. So we found the side effect profile was not worrisome.
And then, most importantly, we want to compare the experience of traditional urodynamics to this system. What we found, one of the key findings, was patients found this device to be more comfortable and allowed them to better reproduce their true urinary symptoms.
I’d mentioned conventional urodynamics is basically a force filling of the bladder. This is not and so they were better able to reproduce their symptoms.
The other thing is that we looked at something called the Net Promoter Score, and that was a concept I wasn’t familiar with before this. I think it’s used a lot in marketing and customer service. And we looked at the Net Promoter Score and basically a negative score states in the medical field the procedure needs improvement. And traditionally, urodynamics had a negative net promoter score, and the Glean urodynamic system actually had a favorable Net Promoter Score, which suggests that patients found it to be a more favorable experience, and that it would actually recommend this to their family and friends.
Timothy Brown
I mean, it sounds like a complete win. You get better data and for the patient. I mean, I don’t know what more you could really ask for.
Jason Kim, MD
Oh, I agree 100 percent. We’re excited to roll it out.
13:50 The Benefit of a Gleaning Device on the Patient Experience
Timothy Brown
That’s great. So for the patients that go through this experience versus the others, it sounds like an easier experience, quicker experience as well. So I imagine that has to be a huge relief a the fact that you can also monitor overnight is very significant, right?
Jason Kim, MD
That’s probably one of the things I’m most excited about. For example, a lot of men with enlarged prostates, their problem is mostly at night, where they have to wake up multiple times at night to urinate. And we never had any data on what was actually happening. So this hopefully will introduce a new era.
14:20 Data Collection and Personalized Patient Care
Timothy Brown
So you get the data, you will insert one of those. You get the data after you remove it, what do you do with the data?
Jason Kim, MD
Well, we don’t get the data real time when it’s in the patient, but this device, once it’s removed, it syncs Bluetooth to a iPad that we have in the office, and all the data is uploaded to the cloud, and there’s a website where we can see all the results, and we can kind of tailor the report in the way we want. And then we print it out.
Timothy Brown
And then you take that information and you develop a plan for the patient?
Jason Kim, MD
Exactly, exactly.
15:38 Evaluation and Urodynamics Testing
Timothy Brown
How long does that measure? Is it like an eight hour period, 12 hour?
Jason Kim, MD
Well, it’s variable. It could be customized to whatever the practitioner needs, you know? So there might be a different workflow for every office, in different situations, in different clinical conditions.
So for example, when we’re doing it, we’re putting some in the morning, and we’re usually telling them to come back after lunch, and then we’re putting some in the afternoon and telling them to come back the next day.
And it all depends on what kind of information I want to capture, but when the that’s the beauty of the system, it’s so easy to do that we can tailor it that way. And in addition, our efficiency is much higher. We’re able to do many more of these studies compared to conventional urodynamics.
Timothy Brown
And so if someone is interested in this, they may have some challenges that they’re facing themselves. How do they how do they go about having this done?
Jason Kim, MD
So just because you have voiding dysfunction doesn’t mean you need this test. You would need to be evaluated by a qualified urogynecologist or urologist, and we have many at Stony Brook.
Once we do the evaluation, if we determine we need urodynamics testing, we will make the recommendation and get you scheduled for this procedure.
16:07 Dr. Kim’s Interest in the Field of Urology
Timothy Brown
So I’m curious what drew you to the field.
Jason Kim, MD
Well, interestingly enough, I I went to Stony Brook for medical schoo, I actually grew up in the Stony Brook area, and so I came in from medical school. I was kind of unsure what I wanted to do. And in my rotations as a third year med student, I happened to rotate on urology, and I realized, number one, they were the happy, friendly surgeons, which made a big deal. And number two, I did realize that urologists are always on the cutting edge for technology, and that really attracted me.
One great example is when I was a resident here we got our first surgical robot, and probably for the first five years or so, it was almost urology exclusively using it. And I’ve noticed in my trainings that urology really is on the forefront of technology, and I really like that, being able to offer my patients the latest.
Timothy Brown
So you’re definitely an academic medicine guy through and through, and you love to research side.
Jason Kim, MD
Yes. yes, I love clinical trials and that we’re involved in multiple clinical trials.
17:10 The Future of Urology and Urodynamics
Timothy Brown
That’s fantastic. So what does the future hold do you think, in the field?
Jason Kim, MD
Well, so voiding dysfunction, as we mentioned, can be extremely disabling, but a lot of patients are embarrassed by the condition and don’t want to come in. And as we get better tests to diagnose patients and things like this, patients may be more willing to come in and talk about it.
I’ve had patients who’ve had traditional urodynamics and told their friends never get that test. I think hopefully in the future, that will change with this new Glean system.
17:42 Closing Remarks
Timothy Brown
Perfect. Well, thank you so much. This was really fascinating.
Jason Kim, MD
All right, thank you for having me.
Timothy Brown
Great information. That’s all the time we have today. And, of course, a special thanks to Dr. Kim for the time and effort of the work that he does. And thank you to our viewers and listeners. If you found this conversation interesting, don’t forget to like and subscribe for more informative on health related content.
Announcer
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