Transvaginal Detrusor Nerve Radiofrequency Ablation for Overactive Bladder

Objectives: To perform a pilot study treating 32 patients with overactive bladder using transvaginal microneedling radiofrequency ablation of a specific anatomic area of the anterior vaginal wall to a depth of 7mm.

Methods: 32 women with known overactive bladder, both primary and refractory, were treated in the office setting using transvaginal detrusor nerve radiofrequency ablation to a depth of 7mm. At 4 weeks post-treatment, we conducted a reassessment of subjects who underwent one treatment session. If less than a 50% improvement was noted, the protocol allowed a second and third treatment session at 4-week intervals. If patients showed more than a 50% improvement, they were followed longitudinally. The Primary outcome was the change in urge incontinent episodes on a three-day voiding diary. Secondary outcomes were a change in the number of frequency episodes, Visual Analog Scale (VAS) pain scores, Incontinence Impact Questionnaire -7 (IIQ-7), Urinary Distress Inventrory-6 (UDI-6), Patient’s Perception of Bladder Condition (PPBC), and a patient global impression of improvement (PGI) questionnaire. We also performed an immediate pain assessment immediately after the procedure was performed. We will follow up with patients at three months, six months, and one year after treatment.

Results: At the time of the writing of this abstract, 32 patients have been treated and followed up at one month, and 13 of these patients have 3-month follow-up. Preliminary results have been very encouraging. All 8 outcomes metrics, were highly statistically significant post-treatment at both one-month and three-month follow up noting significant improvement in their overactive bladder (Table 1). VAS pain scores after each treatment showed minimal to no pain. To date, no patient has met study criteria that would warrant a second treatment.

Conclusions: Radiofrequency ablation using transvaginal microneedling to treat overactive bladder shows very promising outcomes. We look forward to reporting longer-term follow-up on all 32 patients.