The attitudes of Urologists and Gynecologists about overactive bladder and treatment of it in Turkey: A questionnaire survey

Which children are at risk of developing overactive bladder in early adulthood even if lower urinary tract symptoms improve during childhood?

OBJECTIVES

To evaluate more comprehensively the presence of an association between childhood lower urinary tract symptoms and development of adulthood overactive bladder, to determine the group at most risk of overactive bladder in adulthood, and to assess its effects on daily life.

METHODS

A total of 264 patients who were followed up for lower urinary tract symptoms in childhood between 2000 and 2005 were included in this retrospective, cohort study. After a median period of 20 years, these patients with a median current age of 29 (27-35) years were re-evaluated and divided into two groups: those currently with overactive bladder (n = 102, 23.0%), and those without overactive bladder (n = 162, 36.5%). In addition, 180 age-matched overactive bladder patients without a history of childhood lower urinary tract symptoms (n = 180, 40.5%) were included. The primary endpoint was to determine which children are at higher risk of adulthood overactive bladder. The secondary endpoint was to evaluate the effect of history of childhood lower urinary tract symptoms on quality of life in adulthood. The eight-item Overactive Bladder questionnaire, the Pittsburgh Sleep Quality Index, and the Short-Form 36-item Health Survey were administered to all participants. Voiding Dysfunction Symptom Score was evaluated according to childhood medical records.

RESULTS

Overactive bladder in adulthood was observed in 38.6% of patients recovering from childhood lower urinary tract symptoms. They had worse overactive bladder symptom scores and quality of life than those without childhood lower urinary tract symptoms (P < 0.001). Voiding Dysfunction Symptom Score ≥13 (odds ratio 2.54), daytime incontinence (odds ratio 2.01), holding maneuvers (odds ratio 1.82), nocturnal enuresis (odds ratio 1.75) in the pediatric period, and recovery age from all these symptoms of ≥12 years (odds ratio 1.95) were the most unfavorable determinants of development of adulthood overactive bladder.

CONCLUSIONS

Our findings show that children with the above characteristics are at risk of developing overactive bladder later in their lives even if their symptoms improve in childhood.

Exploring literature on knowledge, attitudes, beliefs and practices towards urinary incontinence management: a scoping review

INTRODUCTION AND HYPOTHESIS

Urinary incontinence affects women of all ages, influencing 8.5% of the world's population in 2018. Effective management of urinary incontinence is influenced by patients help-seeking behaviour and services offered by healthcare professionals within the healthcare system. To facilitate behavioural change, it is important to understand the knowledge(Knowledge: "the comprehension and understanding of acquired facts or information about UI in adults"), attitudes (Attitude: "a predisposed perspective which influences nurses' thoughts, feelings, perceptions and behaviours towards care of adults with UI") and beliefs (Beliefs: "a theoretically conceptualized conviction or expectation regarding UI in general") of healthcare practitioners towards urinary incontinence management. The aim of this review is thus to systematically map the existing literature, reporting on how knowledge, attitude, belief and practices towards urinary incontinence management have been explored.

METHODS

Six databases were systematically searched. Included studies were published between January 2013 to January 2020 in English, investigating urinary incontinence management in women.

RESULTS

The search yielded 39 studies, with data emanating from 16 counties. Quantitative, Qualitative and mixed methodologies were used to explore the four concepts of knowledge, attitudes, beliefs and practices. A wide range of healthcare practitioners were questioned and management was explored in five healthcare settings. All factors explored related to the four concepts are reported and factors reaching consensus in included literature were highlighted.

CONCLUSION

The summarized factors can assist further investigations into the four concepts to change healthcare practitioner's behaviour towards urinary incontinence management.

The real-life management of overactive bladder: Turkish Continence Society multicenter prospective cohort study with short-term outcome

INTRODUCTION

Turkish Continence Society aimed to analyze how overactive bladder (OAB) is being managed in routine practice by the urologists in Turkey.

MATERIAL AND METHODS

Fourteen urology departments were randomly selected to represent the whole population in this multicenter study. An online data entry and storage software was created for patient recruitment and data assessment. A survey including demographic data, daily habits, lower urinary tract symptoms, and Turkish-validated OAB-V8 and ICIQ-SF questionnaires were completed by all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician.

RESULTS

A total of 507 patients (394 female and 113 male) were included. Behavioral therapy was recommended to 73.2% of female and 81.4% of male patients although bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively. In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics (P = .431). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (P = .937). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients at the end of 4 months.

CONCLUSIONS

Behavioral therapy and antimuscarinics were the preferred initial treatment modalities of OAB in concordance with the guidelines. Despite guideline recommendations, bladder diaries were not utilized in half of the patients. Insufficient efficacy appeared to be the main reason for treatment modification.

The Urological Society of India survey on urinary incontinence practice patterns among urologists

Introduction:

The Urological Society of India guidelines panel on urinary incontinence (UI) conducted a survey among its members to determine their practice patterns in the management of UI. The results of this survey are reported in this manuscript.

Methods:

An anonymous online survey was carried out among members of the USI to determine their practice patterns regarding UI using a predeveloped questionnaire on using SurveyMonkey^®. A second 4-question randomized telephonic survey of the nonresponders was performed after closure of the online survey. Data were analyzed by R software 3.1.3 (P < 0.05 significant).

Results:

A total of 468 of 2109 (22.2%) members responded to the online survey. Nearly 97% were urologists, 74.8% were working at a private, and 39.4% were in an academic institution. Almost all were managing UI. 84.2% had local access to a urodynamics (UDS) facility. 85.8% would check postvoid residual urine for all the patients. Voiding diary, symptom scores, quality of life scores, pad test, Q-tip test, stress test, uroflow, and cystoscopy were ordered as part of evaluation by 86.0%, 49.8%, 24.4%, 22.0%, 6.0%, 71.8%, 69.2%, and 34.7%, respectively. 47.6% would order a UDS for patients with urgency UI who fail conservative treatment. 36.9% would get UDS prior to all stress UI surgery. Seventy-five percent would make a diagnosis of intrinsic sphincter deficiency. Solifenacin was the first choice for urgency UI in general and darifenacin was preferred in elderly. Botulinum was the first choice for refractory urgency UI. Midurethral sling was the commonest procedure for surgical management of SUI (95.1%). 147 of the 1641 non responders were randomly sampled telephonically. Telephonic respondents had similar access to UDS facility but had performed fewer lifetime number of post-prostatectomy incontinence (PPI) surgeries. Combining data from both surveys, total number of artificial sphincters and PPI surgeries ever performed by USI members was estimated at 375 and 718 respectively.

Conclusion:

This survey provides important new data and elicits critical differences in management practices based on demographics.