Quality of life in patients with overactive bladder: validation and psychometric properties of the Spanish Overactive Bladder Questionnaire-short Form

Laparoscopic Abdominopexy: Surgery for Vaginal Prolapse

Objectives:

We present a new surgery based on the round ligament anatomy that is called laparoscopic abdominopexy, which uses a synthetic mesh without fixation at any pelvic point. The aim of this study is to provide a step-by-step description of the laparoscopic abdominopexy technique and present the first anatomical and functional results of the procedure.

Methods:

This prospective cohort study included patients with apical and anterior vaginal prolapse who were subjected to laparoscopic abdominopexy. Before and after surgery, the Pelvic Organ Prolapse Quantification (POP-Q) scale, Overactive Bladder Questionnaire-Short Form (OABq-SF), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were used to evaluate the vaginal prolapse stage, storage, and sexual symptoms, respectively. The surgical technique is described step by step.

Results:

Twenty patients were included with follow-up times between 6 and 25 months. The mean surgical time was 78.4 minutes. A statistically significant improvement was observed in the Aa (P ≤ 10⁻⁵), Ba (P ≤ 10⁻⁵), C (P = 5 × 10⁻⁵), D (P = .002) and tvl (P = .02) POP-Q points and in OABq-SF (22.2%; P = .02). Successful surgery was observed in 100% of patients for the apical compartment and 90% of patients for the anterior compartment.

Conclusion:

Laparoscopic abdominopexy is a quick, safe, and reproducible surgical technique with beneficial anatomical and functional results that preserve the pelvic floor anatomy.

Prevalence of storage lower urinary tract symptoms in male patients attending Spanish urology office. Urinary urgency as predictor of quality of life

INTRODUCTION

The study sought to determine the symptomatic profile of men with lower urinary tract symptoms (LUTS) who visited a urology clinic in Spain and its impact on their health-related quality of life (HRQL).

MATERIALS AND METHODS

A national, epidemiological cross-sectional study was conducted and included 291 urology clinics. The prevalence of storage LUTS was investigated in 25,482 men. The study collected sociodemographic and clinical data from a subgroup of 1015 patients with storage LUTS who filled out the International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire Short Form (OABq-SF) and Patient Perception of Bladder Condition (PPBC) questionnaires. The impact of urinary urgency on HRQL was analysed.

RESULTS

The prevalence of storage LUTS was 41%, increasing with age: 14.1%, 41.5% and 60.8% for patients aged 18-49, 50-64 and ≥65 years, respectively. Of the 1015 selected patients, only 2.6% had storage symptoms exclusively. Symptom severity (IPSS) increased with age. Nocturia, frequency and urgency were the most common symptoms and had the most impact on HRQL (IPSS and OABq-SF). The number of urgency episodes was inversely correlated with the HRQL (r=-.773; P<.0001). In the multivariate analysis, only the IPSS and OABq-SF bother scores were significant predictors of HRQL (P<.001).

CONCLUSION

Storage LUTS are highly prevalent among patients attending urology clinics in Spain. The severity of the urgency (number of urgency episodes) predicted a poorer quality of life for the patient.

Mapping of the OAB-SF Questionnaire onto EQ-5D in Spanish Patients with Overactive Bladder

BACKGROUND AND OBJECTIVE

Mapping disease-specific measures onto generic preference-based indexes allows estimating utility values in specific conditions to determine gain of quality-adjusted-life-years when the status of condition varies. The aim of this study was to map a disease specific scale, the Overactive Bladder Questionnaire 5-dimensional health classification system (OAB-5D) derived from the Overactive Bladder questionnaire-Short Form (OABq-SF), onto a preference-based scale, the EuroQol-5D (EQ-5D), in a sample of patients with overactive bladder (OAB) in a Spanish population.

METHOD

A survey addressed to value the health states was conducted among 246 patients at 18 clinics of urology from Spain. A total of 43 out of 243 possible health states have been valued, using VAS (Visual Analog Scale) and TTO (time trade-off) techniques. In addition, ordinary least squares (OLS), generalized linear models (GLM) and Tobit models were estimated. Resulting models were compared and the best one was selected in terms of goodness of fit measures, attribute sign, coefficient magnitude, and statistical significance of regression coefficients. Finally, the internal validity of the best model was calculated by bootstrap resampling.

RESULTS

The best model to map the OAB-5D onto EQ-5D could be estimated and the stability of parameter estimations was proved. The mentioned model estimated through OLS regression attained R (2) value of 0.892, with the aggregated data; with GLM (efficient maximum likelihood regression), Pearson χ (2) of 15.3 has been obtained; AIC (Akaike information criterion) = -550.9 and BIC (Bayesian information criterion) = -475.4. OLS model included the following OABq-SF items (and range of weights): A1 (0.102, 0.216); A3 (0.070, 0.171); B3 (0.071, 0.078); B1 (0.076, 0.136); B2 (-0.132, -0.028).

CONCLUSION

It is possible to map the OAB-5D scores onto EQ-5D in the Spanish population, allowing estimating EQ-5D utility scores from OAB specific health conditions.

Cost-effectiveness analysis of fesoterodine flexible dose in newly diagnosed patients with overactive bladder in routine clinical practice in Spain

Objective

To carry out cost-effectiveness analysis from the Spanish National Health System perspective, of treating overactive bladder (OAB), in newly diagnosed patients with two flexible doses of fesoterodine in routine clinical practice.

Patients and methods

Economic evaluation of flexible-dose fesoterodine in newly diagnosed patients, including two treatment groups: standard escalating from 4 to 8 mg or fast escalating to 8 mg. Costs were estimated from health care resources utilization related to OAB, and were expressed in 2015 Euros. Quality-adjusted life-years (QALYs) were obtained from overactive bladder questionnaire-short form. Univariate and probabilistic sensitivity analyses were carried out.

Results

Three hundred and ninety symptomatic OAB patients treated with fesoterodine and newly diagnosed (141 in fast escalating group and 249 in standard escalating) were analyzed. Adjusted health care total costs were not statistically different; difference −€4.1 (confidence interval: −153.3; 25.1) P=0.842. QALYs were higher in fast escalating to high dose vs standard escalating group, resulting in a cost of −€16,020/QALY gained for fast escalating vs standard escalating group.

Conclusion

When the cost-effectiveness threshold is set at a maximum value of €30,000/QALY gained, fesoterodine fast escalating group was cost-effective vs standard escalating group 67.6% of the time. The treatment with fesoterodine, in female patients newly diagnosed, fast escalating to 8 mg was a cost-effective option relative to escalating traditionally from 4 to 8 mg, in the management of OAB in routine clinical practice, from the Spanish National Health System perspective.

How should we address the diagnosis of overactive bladder in women?

OBJECTIVE

Determine the degree of completion, agreement and diagnostic performance of various instruments for assessing the presence and intensity of urgency and other symptoms of idiopathic overactive bladder (OAB) and determine which is the best diagnostic combination.

MATERIAL AND METHODS

Observational, noninterventional, cross-sectional multicentre study on 247 women aged 18 years or older, with a clinical diagnosis of OAB, evaluated in 55 functional urology and urodynamic units. The women completed the Patient Perception of Intensity of Urgency Scale questionnaire, an independent bladder control self-assessment questionnaire (B-SAQ), the Overactive Bladder Questionnaire Short-Form and a 3-day voiding diary (VD3d), and they underwent a urodynamic study (UDS). The degree of completion and agreement among the instruments was assessed using the Kappa index (95% CI) and Cramér's V. The diagnostic performance of each tool and their combination was studied using absolute frequencies of positive cases for each OAB symptom.

RESULTS

The patients mean age was 57.66 years (SD, 13.43). There was a high degree of completion (>85%). The agreement among the instruments was poor or moderate, and there was no agreement with the UDS. The best combination of tools for the diagnosis of OAB in women was the B-SAQ and VD3d.

CONCLUSIONS

The degree of completion of all instruments was high, the agreement between them was poor-moderate and not significant for the UDS. The instruments that had the best diagnostic performance for assessing urgency and other OAB symptoms, providing data on their severity and discomfort, were the B-SAQ and the VD3d.

Adherence to fesoterodine in women with overactive bladder in routine clinical practice

OBJECTIVES

To assess the short-term compliance with fesoterodine treatment and to identify the reasons for lack of adherence and discontinuation in routine clinical practice. The secondary aim was to estimate the patient-reported outcomes.

METHODS

This was an observational retrospective, multicenter study conducted in a sample of women with overactive bladder on fesoterodine treatment for at least three months. Adherence to medication was assessed using the Morisky-Green test. Patient-reported outcomes were assessed using the Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire Short Form (OAB-qSF), and Treatment Benefit Scale (TBS).

RESULTS

One hundred and twenty women with a mean age [standard deviation (SD)] of 62.2 (12.0) years with severe OAB [mean (SD) ICIQ-SF score 13.2 (4.0)] were included. 42.1% of the patients were considered compliant with fesoterodine treatment. The main causes for non-compliance/discontinuation stated by the remaining 57.9% of the patients were adverse events (62.2%) and lack of clinical benefits (20.0%). The illness status as well as the patient-perceived bother occasioned by the OAB symptoms and their impact on the quality of life improved significantly after three months on fesoterodine treatment (p<0.0001). Most of the patients stated that the current state of their urinary problems had greatly improved/ improved.

CONCLUSION

In routine clinical practice, a high percentage of patients were adherent to fesoterodine and perceived the benefit that the treatment provided them three months after starting treatment. However, more than half of the study population failed to comply or discontinued the treatment mainly due to intolerance or lack of efficacy.