Dr. Anjali Kapoor

So that is a limited factor.

Right now, it's just for sacral.

I haven't had any issues with Botox.

And then with implantable tibial, it depends.

A lot of times for Medicare and Medicare Advantage plans, we do it regardless, the prior auth.

With the stage approach, what I've noticed is a lot of my patients who have concomitant fecal incontinence with urge incontinence, or if they come to me just with fecal incontinence and I offer them an interstim or a trial, for those patients, I end up offering potentially a staged approach just so that they can get a longer trial period out of the stage one to really determine if their fecal incontinence episodes are improving over that time.

Exactly, yeah.

Bigger issue with quality of life and it can be life-changing once they kind of get a taste of the therapy.

Yes.

And with the WISER program so far, I would say it hasn't been an issue in actually obtaining the authorization.

It is just extra paperwork in terms of submitting the clinical notes, the bladder diary.

If they have urodynamics, we submit that justification for, you know, how urgent continence is affecting their quality of life.

It's a lot of details that we just have to submit.

Right, so that was very important.

Yeah, well, luckily I have people to help me with that.

In terms of durability of sacral neuromodulation devices, what on average are you seeing nowadays before someone, say, needs to replace a battery?

Yeah.

Aside from lead migration, are there other reasons for needing to revise the lead?

So we know that overactive bladder in general represents a huge cost burden to the US health care system because patients often do go many years on therapies that may be ineffective.

And recently, again, at SUFU, it gave us a lot of new talking points.