Dr. Anjali Kapoor

Do you tend to hit roadblocks when prescribing the beta-3s first with insurance companies requesting that patients try sometimes two, three multiple anticholinergic medications before approving a beta-3 agonist?

Right.

Yeah.

It often just ends up delaying care and they don't really get the relief out of it that they're looking for.

Right.

And after the four weeks, are you moving on to a different medication, adding a second one, or typically at that point counseling them about the minimally invasive therapies?

No, that's a great idea, supplementing the vaginal estrogen with the medication to improve those symptoms.

So now, since we're kind of at the point of patients failing medications, we'll segue into those minimally invasive therapies.

I want to go through each therapy individually, and we can go through risks, benefits, how you counsel your patients, and outcomes.

So

Do you feel in general with the guidelines being our basis with the update, do you feel like you are offering minimally invasive therapies sooner in your practice?

Who would you say is your ideal Botox patient?

And do you always start with 100 units for your idiopathic overactive bladder patients?

Yeah, that may change in the near future.

And you're doing all of your Botox injections in general in the office, correct?

So now we'll move on to tibial nerve stimulation.

So we know that percutaneous tibial nerve stimulation has been around for quite a long time.

And I'd say about five years ago, implantable tibial nerve stimulation came about.

Can you talk about the...

Reasons behind why implantable tibial nerve stimulation is a newer thing to offer for patients who were previously coming to the office once a week, every 12 weeks, and then potentially doing maintenance PTNS after that.