November is Bladder Health Month, an initiative of the American Urological Association’s Urology Care Foundation. To learn about how the foundation hopes to achieve the objectives of Bladder Health Month, Renal & Urology News spoke with Brian Stork, MD, chair of the foundation’s Publication and Technology Committee and Clinical Assistant Professor of Urology at Michigan Medicine West Shore Urology in Muskegon.
Why Bladder Health Month? What are its goals?
Dr Stork: Millions of Americans struggle with the impacts of bladder conditions and disease such as urinary incontinence, overactive, and underactive bladder, interstitial cystitis, urinary tract infections, nocturia, bedwetting, bladder cancer, and neurogenic bladder on a daily basis.
These conditions have a significant impact on an individual’s health and quality of life, and result in substantial health costs (estimated to be more than $70 billion per year).
The goal of bladder health month is to encourage individuals to engage in dialogue with their healthcare providers about their symptoms and to empower them with educational resources they can use to actively participate in their individual treatment plan and ongoing care.
How can urologists help to achieve those goals?
Dr Stork: The Urology Care Foundation, the official foundation of the American Urological Association, has developed an extensive online library of patient education materials. In addition to the teaching and conversation that takes place in the office, physicians can help by directing their patients to these resources.
In addition to online written resources and videos, physicians can help by making patients aware of specific advocacy groups that can offer further education and social support for specific bladder diagnosis and conditions.
What do you see as the most important advances in bladder care in the past 5 or 10 years?
Dr Stork: In the past decade we have seen the addition of a broad array of anticholinergic medications as well as mirabegron, a beta-3 adrenergic agonist, for symptoms of urinary urgency, frequency and urge incontinence. We have also seen a dramatic uptake in the use of OnabotulinumtoxinA, peripheral tibial nerve stimulation, and neuromodulation for neurogenic and non-neurogenic symptoms of urinary urgency, frequency, and urge incontinence refractory to oral medications.
In non-invasive bladder cancer, we have seen greater use of post-operative mitomycin C and, more recently, gemcitabine by urologists following biopsy and/or transurethral resection of bladder tumors in an effort to reduce recurrence.
In metastatic bladder cancer, research has given us a new understanding of bladder cancer genetics and the drivers of response to chemotherapy. We have also seen a lot of interest and use recently of immunotherapy for advanced disease.
In your view, what are the most underappreciated or undertreated bladder problems in the US?
Dr Stork: Urinary incontinence continues to be a common condition in the general population. Failure to seek treatment may, in part, be due to embarrassment about the condition. In addition, patient simply may not be aware of all of the treatment options that are currently available to address symptoms of urinary incontinence.
Recurrent urinary tract infections, and the complications that accompany them, continue to be a costly problem. There is a growing need for improved antibiotic stewardship among physicians in all specialties as well as an ongoing need to recognize atrophic vaginitis in post-menopausal women as a potentially treatable risk factor for recurrent urinary tract infections.
Finally, interstitial cystitis continues to be a poorly understand bladder condition with significant variability in how it is diagnosed and managed.
Do you see any impediments to research efforts?
Dr Stork: Obtaining funding for issues related to bladder health remains an ongoing challenge.
In urology, we have historically devoted much of our research focus toward oncology. We need to recognize, support, and encourage young researchers who contribute to urology research outside of oncology.
Where would you like to see a greater research focus? Are there any areas of bladder research that have been neglected?
Dr Stork: Hypotonic and neurogenic bladder affect millions of Americans and treatment options for interstitial cystitis and pelvic pain have changed very little over the course of the past decade.
We are really in our infancy in what we can currently offer patients for these conditions.
Multi-drug resistant urinary tract infections are becoming an increasing problem. There is a real need for research into new generations of antibiotics.
As vaping and use of e-cigarettes continue to increase, we really need studies to better understand the effects of these products on the bladder. Improved biomarkers are needed to help risk stratify patients with bladder cancer and to reduce the need for cystoscopy. Finally, we need to find ways to reduce cystectomy-related surgical morbidity through better prehab and enhance recovery following surgery.
What are some of the big unknowns in bladder health?
Dr Stork: One of the big questions physicians currently face is how we are going to treat multidrug-resistant urinary tract infections in the future. Also unknown is what promise stem cell therapy, as well as tissue and organ engineering, hold for our patients in the future.
Finally, there has been a lot of discussion recently about the use of artificial intelligence in medicine. How artificial intelligence will lead to improved patient care really remains to be seen.
What message would you like to send to practicing urologists?
Dr Stork: The Urology Care Foundation has developed educational resources for patients that are rigorously vetted, follow AUA guidelines, and are available for free. Posters and educational resources for physician offices are available at very low, and oftentimes no, cost.
The Urology Care Foundation has also organized and leads the Bladder Health Alliance, a coalition of 30 patient and physician advocacy organizations that can provide additional education resources, and oftentimes social support, for patients. All of these resources can be found on line at UrologyHealth.org.