Dr. Jason Kim

You can start with procedural intervention if you'd like after discussion with a patient.

Although the guidelines remove the need for stepwise therapy, unfortunately, a lot of insurance companies still require it.

So we still kind of practice in that way for the most part.

I think the other thing is the emphasis on shared decision making.

I know I do a lot of shared decision making with my patients, especially when it comes to procedural intervention.

There are multiple different types of procedures and I discuss them all and have a discussion about pros and cons and figure out what is best for each patient.

I don't think any therapy is best for every patient.

I think there was also some things about telemedicine in there.

I've utilized that very well in my practice.

Typically, for example, if we start pharmacotherapy, instead of having the patient come in, I'll often do a telemedicine, which I think is more efficient for the patient, for our practice, and allows us to see more patients and get them in quicker.

I think patients would absolutely go for a procedural intervention.

You know, a lot of patients are very frustrated with their condition.

I would want to do a couple basic tests, such as a post-void residual and check a UA before committing to the procedure.

However, it's reasonable to discuss it, I think, at the first telemedicine appointment.

Overactive bladder can have such a negative impact on a patient's quality of life and their overall well-being that a lot of times they just want to undergo therapy that may be longer lasting and without being on a medication.

patients have a lot of concerns about medication side effects and cost and things like that.

Well, generally for idiopathic overactive bladder, for the vast majority of the cases, I don't feel much of a workup is necessary other than maybe a pulse void residual in urinalysis.

However, if the PBR is elevated, that might cause me some concern.

If they have pelvic organ prolapse, I may consider other intervention.

I know it's beyond the scope of what we're talking to, but if there are any neurologic issues, I may consider further workup.