Set It and Forget It: How eCoin Is Revolutionizing OAB Treatment

 I sat down with Jim Surek, CEO of Valencia Technologies, to explore eCoin, an innovative tibial nerve stimulator designed to treat overactive bladder (OAB) with fewer visits, fewer side effects, and more freedom.

Unlike traditional sacral nerve stimulation or ongoing Botox treatments, eCoin is a nickel-sized device implanted near the ankle that delivers consistent, effective relief. It's minimally invasive, easy to implant in an outpatient or office setting, and requires little follow-up.

We discuss:

• How eCoin compares to other third-line OAB treatments
• What makes it simpler and more accessible for both patients and providers
• What women can expect from the implant procedure and its long-term effectiveness
• How it's helping improve patient outcomes and free up busy practices
• The exciting future of this device for broader pelvic health conditions

Whether you're a patient living with urgency and frequency or a provider looking for better options, this episode brings a much-needed look into the evolving treatment landscape for OAB.

Timeline:

00:30 Introduction 

01:02 Overview of the Eco Device

03:31 Clinical Study Results and Patient Feedback

04:55 Battery Life and Replacement

06:53 Surgical Procedure and Placement

11:30 Patient Experience and Benefits

15:24 Future Developments and Company Vision

18:50 Conclusion and Final Thoughts

Transcript

I'm here today with Jim Surek, who is the CEO of Valencia, and they make Eco, which is a treatment for overactive bladder. And I just wanted to talk about this new technology, this implantable device to help women who are suffering with overactive bladder.

So welcome. Thank you so much for being here with me today. Oh, thank you so much. I'm, I'm, , very appreciative of you asking and excited to talk to you. I think, you know, this technology has been or is going to be , a game changer for a lot of women just because it doesn't have the side effects of medications and it feels a little bit simpler to place than the sacral nerve stimulators.

, can you just tell me a little bit about the device  and how it works? Sure. So what we've done, , and the genius behind the product was, as you said just now, is to keep it simple. So the whole idea behind it was to create a form factor that would, , fit nicely into the ankle for tibial stimulation.

, that would produce enough energy that it could last a number of years. And so that more patients would be attracted to this type of therapy , versus Botox, PTNS, the ongoing use of medication, and as we know, there's only about 3% of the population that ever goes to a sacral nerve stimulation device.

 Not because it doesn't work, not because it's good therapy, just because people choose not to do It's. Been going on since 1997 when, , the first, , sacral nerve stimulators came out. So the device was created to be able to provide that for this 97% of the population. Give them an opportunity to choose something so.

As quite simply to get 'em out of your office. Yeah. For a number of years. Right. And to give them the therapy that's going to provide them an opportunity to live and get back to that normal life. And so when you really look at it, we're providing all of this therapy. We're providing opportunities to get patients out of your practice.

Getting patients, new patients into your practice, because we're getting those patients out, really freeing up the healthcare system and, and the therapy works. It's just as equivalent as everything else out there. We don't claim superiority. We claim equivalents, but we can attract more patients and this is all done, really all this value that's created, whether it's clinical and economic, is the economic value for a patient.

Is huge as well as for, the healthcare system to get these patients out and get them back to a normal life. And,  we do this all through a nickel size stimulator that goes into the tibia. How well does it work? So in our clinical study we had, what is it? 75% of the patients had greater than 50% relief.

Yeah.  And 25% of the patients around 25%. We,  as the numbers come in, they fluctuate and somebody will call me after this and say it's 23.857%, but it's around 25% of patients actually have zero occurrences. , so it works very well  and like I said, it's equivalent to what's out there and what's really attractive is that 89% of the patients that get the therapy would recommend it to another patient.

So yeah, the patient, which is always  the highest bar, right? If you're willing to recommend it to a friend or family member. Yep. So  I always think of overactive bladder treatments as being 60 to 80% effective. Right. It feels like they all fall into that window, and  I think you're right.

You know, with Botox, patients come into the office about every six months. When we do the percutaneous nerve stimulation, they have to come, which is tibial two, they come into the office once a week for 12 weeks, and then for maintenance. And, you know, that's hard from an office perspective, just managing that flow.

But it's really hard for patients too to come into the office that frequently. And so I think you're really right. People are looking for a treatment that,  that works  and is, you know, they don't really have to think about it or get a lot of maintenance. How long does the battery last? Yeah, no, it's a good question.

I know there's a lot of,  chatter out there about our battery. What's interesting is. Our battery. So it depends on how much energy is used, right? Right. So it could last, you know, if the lowest amount of energy, the battery could last seven plus years. But , the truth  is that on average it's three to six years is what we're finding.

And we're actually very excited. We'll soon come out with some information. Showing the actual battery life. , it's greater than three years on average and, it's getting higher as we get better, with programming and, understanding the patient's therapy and what they need. So we're really excited about it.

Do you have a goal for , the battery length that you want optimally? Yeah, so we're, we actually have, it's funny is it's not our goal. It's your goal, right? Right. We go and talk to surgeons, right? And we talk to patients and we say what's optimal and we get anywhere from, you know and it's, and if there's always  a qualification to that question because then, you know, doctors and surgeons out there will say, you know, well, you've got single nerve modulation in the last 10 plus years.

And then they'll say, but. Certain studies show that 30% of sacral nerve modulation,  devices are revised RX explan within one year and over eight years, it's 40 plus percent. So then you get to this battery life and go, well, is it about the battery? Is it about  the comfort, the function of life? So it's a very nuanced question because it's not necessarily about the battery, it's about the whole system itself.

And so what we're shooting for is anywhere six plus years. Yeah. And we think we can get to seven or eight year battery life. And so that's our goal. But , it's gonna be truly based on battery life, not really about anything else that's taking place. Yeah. I mean, you're right. We want the therapy to last for as long as possible, right?

Yeah. , and it is more than just  the battery life. I've, so I've placed these, I've placed a couple in the office. I've actually taken a, taken one out and replaced it. And it's not hard to do. I mean, the repla, I mean, we did it in the office. We did it under local. It was pretty straightforward.

Do you have any data about how well that second battery works? Or if the scar tissue interferes with how well it works. Yeah. You know, we don't, because we haven't had many implants. Yeah. And so when we replace them, what we do is we'll walk over time. Yeah. The life of that battery and is if the patient doesn't come back, we know it's working.

So we don't really, we're not, we don't have a lot of data because it's working. And what happens with,  neuromodulation and I actually. Have a pretty big background in neuromodulation. I created the advanced Bionics, sales organization that is now the pain management business of Boston Scientific.

So I'm very familiar with implantable,  neuromodulation devices. I. So we're able to overcome that scar tissue just by turning up the therapy a little bit. Okay? But we're not seeing that as an issue. And the other thing with scar tissue, scar tissue comes and goes. It doesn't go away completely.

The thickness and stuff will vary. So,  with that, we're not seeing, you know, scar tissue as an issue at all. Yeah, so I've heard some people say that, you know, eco is planted above the fascia. That planning below the fascia is more accurate and stimulating in the OR and testing the nerve function is important.

Those aren't things that we do with eco, , it's placed in a very systematic fas. Do you think that's a negative? No. Everything we do, our tagline is simply uncomplicated. Right? And that's everything from. Working with the office to, with you, the apps, the surgery center, to keep everything simply uncomplicated and,  with the fascia.

And going sub fascia is, makes it more complicated and we have not seen, there is no data, there is no comparative data that's out there to say, being on top of the fascia. Is better than being subcutaneous, sitting on top of the fascia. The other thing  is that the eco, because it's the size of that nickel, the tibial nerve is quite large,  that  in the ankle.

And so we're able  to really generate a wide field of energy to be able to attack that tibial nerve. So without comparative data, without any sort of study to say one's better than the other, it's really just supposition,  to, to an argument of,    thinking one surgical procedure  is better just because you're closer to the nerve and there's nothing to show that being true.

What about testing? Do you think it needs to be tested in the or, um, or is the placement so systematic with equine that you know you're gonna get the nerve? It's so systematic. We get the nerve. It's, yeah, we have not, we have not seen really,  any information, any data to say that, this is, challenging in any way.

Yeah.  So it's, I mean, it's just quite simple. It simply works. We've thousands of implants out there and the subcutaneous,  above the fascia, it just simply works. Yeah. I have to tell you, I'm a pelvic surgeon. I'm very comfortable operating in the pelvis, in the abdomen. Operating on the ankle is  a whole new ball game and is very intimidating initially.

And so making it so simple  was really,  attractive  to me, because  it is just a very different place in the body and it heals so differently. Yeah, well, it's, and we did it once again to take it another step further, why above the fascia for long-term use. Eventually we're gonna bring this to your office.

So right now, today it has to be done in an A SC or an OR hospital based, but eventually we're gonna bring it to an A SC. And so when you look at other therapies out there, and a subfascial procedure. That becomes quite intimidating in an office space. Yeah. Because you're opening up the anatomy and you're exposing it to arteries, you're exposing it to the nerve.

And, we wanted to make sure that we made it also simply uncomplicated to move right into the office space without having to have those concerns. Yeah. You still have to be delicate with your procedure and your technique, , but you don't. You're not gonna expose yourself to those elements. Yeah. I love the idea of doing it in the office, and I think most patients do too.

It just makes it that much,  easier, as long as you can do it in a fairly  comfortable way. What do you think patients like the best about this procedure or this device? I think it's, you know, it's interesting. I think if I ask 10 patients, I might get 10 different answers. True. But,  but ultimately it's the problem solved.

We have great results and, they're, they come in and they're done within 20 minutes, 30, or I shouldn't say that,  the procedure, it takes longer than that. But they walk home, they go home and they go on with their life. There is, there's no two procedures, right? It's just one simple procedure and you're done and you're on with your life.

 It's, I it's almost, it's almost so benign , in the effect that the patients just. Excuse me. Just love that, right? Yeah. It's just, when you think about it, you're like, so this is all we have to do. I don't have to come back every week. I don't have to come back every month. I don't have to get injections, I don't have to do anything else.

And with our programming, so with unlike traditional, conventional,  sacral nerve modulation, and we don't feel like we're competing with them 'cause we're really going after a different therapy. But to put it in context, once we implant the patient. We don't see that patient. Again, 90% of the patients get two programmings or less, and then we don't see 'em.

So they're not coming back to your practice again to eat up time and space and resources for that programming. So you mentioned like testing before, what even after surgery? We don't have testing. We don't have an app. We don't have programmers. We don't have any of that. , because. It's so simple to use.

Yeah. You don't think patients want a program so they can turn it up and turn it down like they do with sacral neurostimulation? No, because based on my experience in the pain management, that's a disaster. No,  I agree with you. We give patients remotes and it's,  the technology is frequently intimidating.

And there are just so many places it can go off the rails. I mean, I think most people do just wanna place it and have it work and have it, not think about it. Are there any negatives that you hear about it? It's like being the CEO you wanna be able to come up with something that's, , you're not all positive.

Right. But,   I think the negative,  it actually, it goes,  beyond our therapy. I think the negative mostly with patients is that it doesn't work for everyone. Yeah. Sacral nerve doesn't work for everyone. PTNS doesn't work. Medication doesn't work. So I think that's just an overwhelming,  response.

Two, it is, why didn't it work for this one patient? And we feel terrible about that, but yeah, at least there's now still other options to go after. So, and it would be nice to stratify, you know, if you could figure out who it doesn't work for and push those patients in a different direction. Correct. , but , it always seems like a little bit of trial and error.

One of the things that I was really worried about it is,  when it stimulates, it just automatically stimulates. And I was really worried  that stimulation would be uncomfortable or startling to the patient. Mostly startling. So if you were driving it might be, a hazard, but,  nobody has said that to me at all.

Yeah. What we, yeah. It's never happened. We've, you know, if somebody feels like, Hey, I don't like the way it feels, and it's just a tingle Yeah. We can turn it out, right? Yeah. But other,  and most people don't feel it, right. Almost. Exactly. So there's always nuances and I always say a patient is in the end of one.

I'm sure you agree, right? How Yeah. How they respond to things and so. As we communicate with like your office, your patients, and we tell 'em how simple it is, it's actually very relaxing. It brings a lot of confidence and, going back to your question of like what patients like, it's set it and forget it.

 That's really what we do and we message that to patients is that, you know, it's gonna take six to eight weeks before you really see the therapy start to work. But after that, set it and forget it, we're done. We won't, we'll see you in a couple years when you need a new one, so. Yeah. Yeah. What's next for you guys?

We, we're actually coming out with a,  a new programmer. We have a generation two product that will be,  submitting to the FDA and that's for a longer battery life and some other features. And we're just gonna continue looking at this device, not make it uncomplicated. Somebody asked me if. We wanted an app and I said to for patients and I said, yeah, I want an app that says set it and forget it and tell a friend.

And that's it. That's the app. So we're really trying to attack the market, get, you know, instead of, having a percent of patients that don't get therapy. What can we do as we investigate this to get more patients to enjoy the therapy, get benefit from the therapy and, more studies coming out with more indications.

We're really gonna, we've, we're building this company to last, to go for a long time and really just provide all that clinical and economic and strategic value for the patient, the practice, the doctor, the healthcare system to really help. We think about it, 32 million people suffer from OAB and only 3% go to a third line therapy.

How can we impact that, right? Yeah. How can we change that? So we're very passionate about getting those patients outta your practice. Not just for those patients, but the patients that are waiting to come into a practice to see somebody. Yeah. So every time we take a patient, like from PTNS to,  an eco device, we open up, we, the device, the value it brings, opens up an opportunity to bring a new patient in for 14 patient visits because you're getting that patient outta your practice.

Well, and I think that's such an important problem right now. My office, the whole healthcare system is just so backed up. So anything we can do to improve throughput in a positive way for the office and the patient is so very important. Yeah. And so that's why when we really talk about what we're bringing to the market, it isn't a device.

It isn't just a nickel size simulator. It is true value to impact the healthcare system. Your offices, your practice, your patients,  along a larger continuum from those patients waiting four months to get in. Yeah. How can we help reduce that, right. By using this device, that patient that gets the device benefits, but so does everybody behind that patient.

Right? Right. And so it's kind of exciting when you, you think about it from that perspective. I love the fact that you guys are thinking about it from that perspective and anything you can do to increase the dialogue. So patients talk about treatments a little bit more and then you know, it, people become more aware of the different treatments.

I mean, so many women don't realize that there are third line treatments and different things that we can do, and it's not just medications or they're not just stuck with it. So many people think it's just part of aging that they have to accept, which is definitely not true. , can I ask you what other indications you're looking at?

 I'm not supposed to say. Okay,  but we're looking at a few, and it's a matter of we've rebooted the company in January and we're, we've put out, we've really reconstituted the entire organization, very excited about what we're doing. And now that we're looking at different indications, it's a matter of when we pull the trigger.

Fecal incontinence is, I'm gonna share that. Yeah, that's one right. That we're looking at. But then there are many others for,  for different indications to get to a broader, group of people that can benefit from this. Yeah. That's so exciting. Well, thank you so much for all that you do. I think this is a great product and I've seen it, I mean, in my practice it's exactly what you say, where about 80% of the women are so very, very pleased with it.

And then it doesn't work and you know about 20%. But,  the, for the people that it works with, it, it is a total life changer and, they're very happy to not be seeing me. Yeah, yeah, no, exactly. You know, and, going back to that patient, I had a, it's a little off, off color here, but my daughter needed a procedure done and, she lives in Florida, so I flew down.

To me with the doc before everything happened and  I paid $50 to park and Right. And then I'm looking around going, oh my gosh, look at all these people paying 50 bucks to park and go in the office. That's before the copay. And , yeah, and just seeing this, you know, this process and I said, wow,  with Eco, and we talked about the patients before.

If we can get these patients not to have to find a family member to take them. Yeah. Right. Because that, that impacts that family's financial situation, taking off work, paying for parking, gas time, all of that. So we're looking at this truly from how do we impact so many different people and so many different ways in the treatment of one patient.

We, we don't really sometimes connect the dots 'cause we're so busy. But when you really start to connect those dots, patients start talking to each other. Yeah. Right. Patients start saying, Hey, I don't have to bother my son, my daughter,  or whoever to help me get to my healthcare. This really is opening up.

That opportunity to treat so many people and help so many people. And that's what we're very passionate about. , you can tell I'm pretty passionate about it. You are very passionate about it. I've been doing this for 30 some odd years with startups and, it's just very exciting and, we're happy to collaborate and excited to collaborate with surgeons like yourself and others who see that vision, who see what's possible, and they keep encouraging us to be uncomplicated.

Right. Please don't make it complicated, so, no. Yeah. Patients don't want it to be complicated and. It's such a nice device because it, it's a very easy device to implant in someone who's older and more frail. Because we can do it in, you know, \ the office setting. And it's very, it's in such an easy procedure, but it also works well for younger patients too.

Right. So it, it fits just a huge spectrum  of people. Yeah. Yeah. So very exciting. Yeah. And their families. I mean, you're right. Overactive bladder does become kind of , a family event for a lot of, for a lot of women, so, yep. Yeah. All right. Well, thank you so much. This has been great. Thank you.