Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a common clinical problem with associated morbidities both in men and women. Although real-life management strategies have been examined among urologists (URO), treatment choices may differ between different specialties. In the present study, an online survey was conducted to determine and compare the management strategies and clinical preferences of UROs, obstetricians/gynecologists (OB/GYN), and geriatricians (GER) in the treatment of OAB in their daily practices. METHODS: Between December 2020 and February 2021, an online questionnaire was sent to URO, OB/GYN, and GER specialists/residents. Current strategies and attitudes toward treatment of OAB in patients <65 years were compared between URO and OB/GYN, whereas the responses were compared between all three specialties in patients ≥65 years. RESULTS: A total of 733 specialists/physicians (433 URO, 236 OB/GYN, and 64 GER) completed the online survey. Patients with OAB were more likely to present to URO compared to OB/GYN and GER (p = 0.001). A combination of behavioral modification and pharmacotherapy (antimuscarinics and/or beta-3 agonists) were chosen for the initial treatment of patients with OAB in both specialties with a significantly higher proportion by URO than by OB/GYN (51.9% vs. 38.1%; p = 0.001). Antimuscarinics were the most frequently prescribed medications by both the URO and OB/GYN specialties (81.8% vs. 78.4%; p = 0.27). Combination therapy with antimuscarinics was preferred more often by URO (91.5% vs. 77.1%; p = 0.001) when no or an inadequate response after initial treatment occurred. Multiple medication use, comorbidities, and risk of cognitive side effects affected medication preference by all specialists, especially by GER (p = 0.018). CONCLUSIONS: Patients with OAB present to UROs, OB/GYN and GER more frequently compared to other specialities. Although antimuscarinics and beta-3 adrenoceptor agonists are equally recommended as first-line pharmacotherapy for OAB, antimuscarinics were preferred for most patients as the initial molecule by all specialties. Beta-3 agonists are increasingly preferred for elderly patients.

Sacral neuromodulation in patients with detrusor underactivity: Is biological sex an indicator?

OBJECTIVES: This study aimed to report sacral neuromodulation (SNM) outcomes in detrusor underactivity (DU). METHODS: A multicentric, multinational, retrospective case series was conducted between March 2017 and June 2021 in three different referral centers. Initial test phase stimulation included either a percutaneous nerve evaluation (PNE) or an advanced lead evaluation test phase (ALTP) before permanent SNM implantation. The test phases were performed under local anesthesia, either in the outpatient (PNE) or operating room (ALTP), in the prone position, which was implanted in the third or fourth sacral foramina under fluoroscopic guidance. Patients with favorable response to the initial test phase during the first 2 weeks underwent the implantable pulse generator (IPG) implantation (Medtronic neurostimulation generator device InterStim™). Favorable response was defined as ≥ 50% improvement in symptoms, frequency of clean intermittent catheterization (CIC) and/or decrease in postvoid residual (PVR), increase in voided volume, or improvement in bladder voiding efficiency (BVE) based on the bladder diary. RESULTS: Fifty-eight patients were recruited with a mean age of 39.95 ± 15.28 years. Among the 58 cases, 36 (62.1%) patients responded to the initial stage. Of these, 12 patients (30.8%) with non-neurogenic etiology and nine patients (52.9%) with neurologic etiology did not respond to the initial test phase; thus, they did not undergo full implantation (p = 0.141). Voided volume, PVR, and the median maximum flow rate (Qmax) improved significantly (p < 0.001) in both sexes; however, there was no statistical difference between both genders. Most female cases (78.3%), and nearly half of the men (51.4%), responded to the test phase and were candidates for the IPG phase. Among the 35 cases who underwent IPG, 27 patients (72.2% of males, and 77.8% of females; p = 0.700) had a favorable response to IPG. 46.6% of patients had a successful outcome at the end of the study. CONCLUSION: This multicentric study showed that SNM effectively and safely provided symptom improvement in refractory DU in males similar to females which is an important finding as previously it has been suggested that SNM works better in nonobstructive urinary retention in women and not in women.

Prevalence of female urinary incontinence in the developing world: A systematic review and meta-analysis-A Report from the Developing World Committee of the International Continence Society and Iranian Research Center for Evidence Based Medicine.

AIMS: The prevalence of urinary incontinence (UI) in the developing world varies widely. Factors influencing prevalence rates are a key area of interest, and knowledge of these would provide appropriate planning for preventive primary and secondary health care programs. The objective of this report was to synthesize the best available evidence to determine UI prevalence rates in adult women in a population setting. METHODS: A comprehensive search strategy was employed to find published and unpublished studies. Databases searched included PubMed, Embase, Scopus, Web of Science, and Google Scholar. We used the standardized Joanna Briggs Institute Meta-Analysis of Statistics, Assessment, and Review Instrument to appraise the included studies. RESULTS: In total, 54 studies with 138,722 women aged 10 to 90 years were included in this meta-analysis. Prevalence of UI ranged from 2.8% in Nigeria to 57.7% in Iran. The total prevalence of UI was 25.7% (95% CI: 22.3-29.5) and the prevalence rates for stress, urgency, and mixed UI were 12.6% (95% CI: 10.3-15.4), 5.3% (95% CI: 3.4-8.3), and 9.1% (95% CI: 7.0-11.8), respectively. When we excluded the elderly population, UI prevalence only slightly changed (26.2%; 95% CI: 22.6-30.2). Prevalence rates varied considerably during different recall periods, ranging from 15.6% for UI during the last 12 months to 41.2% for UI during the last 3 months. However, the study quality and use of validated vs nonvalidated questionnaires only had a minor impact on the prevalence rates. CONCLUSIONS: The prevalence, methodology, and definition of UI vary widely. A large-scale multinational study with a homogeneous methodology is necessary to correctly calculate and compare the prevalence rates to improve health policies in the developing world.

The International Continence Society (ICS) report on the terminology for male lower urinary tract surgery.

INTRODUCTION: In the development of terminology of the lower urinary tract (LUT), due to its increasing complexity, the terminology for male LUT surgery needs to be updated using a male-specific approach and via a clinically-based consensus report. METHODS: This report combines the input of members of the Standardization Committee of the International Continence Society in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 14 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for male LUT and pelvic floor surgery, encompassing 149 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in male LUT surgery. Figures have not been included to avoid any preference or bias towards a specific procedure. CONCLUSIONS: A consensus-based Terminology Report for male LUT surgery has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population.

AIMS: To investigate the efficacy and safety of intradetrusor onabotulinumtoxinA (onaBoNT-A) injection in patients with overactive bladder (OAB) refractory to antimuscarinic treatment. METHODS: A total of 80 patients with OAB symptoms were enrolled in this prospective multicenter study and received 100 U intradetrusor onaBoNT-A injection.The changes from baseline in the frequency of voiding, urge urinary incontinence (UI) and urge episodes, mean and maximum bladder capacities, uroflowmetry, post-void residual urine volume (PVR), quality of life score, and treatment benefit scale score were assessed. The need for a second injection,and treatment-related adverse events were also examined postoperatively. RESULTS: OnaBoNT-A injection significantly decreased the UI episodes(P = 0.0001), the mean voiding frequency (P = 0.0001), and the urgency episodes (P = 0.0001) in the third month compared to baseline. Similarly, the mean bladder capacity, and maximal bladder capacity were increased (P < 0,05). The quality of life scores improved by 57.1% compared to the pre-treatment rate (P = 0,0001). No significant change was observed in the PVR or maximum flow rate. Urinary retention developed in 3 (3.75%) patients and urinary infection and transient hematuria were observed in five patients (6.25%) each. The UI episodes, voiding frequency and urgency episodes were significantly lower at the 9th month than at baseline (all P = 0.0001). Overall 67% of the patients continued to experience benefits from the injection. Sixteen patients (20%) required a second injection in the third month. Eight patients were lost to follow-up at the last visit in the 9th month, and 34 of the remaining 56 patients required a second injection at the 9th month. Cumulatively, 50 (63%) patients needed re-injections. CONCLUSIONS: Our results demonstrated that the onaBoNT-A injection produced significant improvement in all OAB symptoms with a low incidence of treatment related adverse events.

Evaluation of sexual function in women at two stages of multiple sclerosis.

PURPOSE: In the present study, we aimed to evaluate the sexual function in patients with multiple sclerosis (MS) who were examined in two subgroups and compare the results to the control group with a validated questionnaire. METHODS: A total of 23 consecutive female MS patients divided into groups with relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS) and 45 healthy control subjects were included into the study. The inclusion criteria were as follows: Definite MS, age between 18 and 60 years and an Expanded Disability Status Scale (EDSS) score of <8. The neurologic impairment, the disability and the independence of the patient, and cognitive performances were measured, and also the effect of MS is evaluated by EDSS. RESULTS: No statistically significant difference was found between two groups. FSFI scores in both groups were significantly lower than the control group. Domain scores for desire, arousal, orgasm, pain, lubrication and satisfaction measured between RRMS and SPMS patients showed no significant difference. Comparing each domain score for arousal, orgasm and satisfaction revealed significantly lower scores in RRMS and SPMS patients compared to control group. CONCLUSIONS: In this study, we detected statistically significant decrease in FSFI scores in two groups of MS compared to healthy controls. We could not define a difference in sexual function in different stages of MS in women and a statistically significant negative correlation between EDSS and FSFI scores in the two subgroups of MS.

Impact of the COVID-19 Pandemic on Functional Urology Practice: A Nationwide Survey From Turkey.

Objective: Routine urology practice has changed with the coronavirus disease-2019 pandemic. We aim to determine the urologists' functional urology practice during the pandemic by an online questionnaire. Methods: An online questionnaire was conducted to assess the functional urology practice of Turkish urologists' during the pandemic. The workplace, positioning as a pandemic hospital, involvement in pandemic clinics, and the relevance to functional urology were questioned. We also inquired about outpatient services, diagnostic tests, and elective surgeries during the pandemic compared with their routine practice. Results: One hundred and fifty-two participants completed the questionnaire. Of these, 32.2% replied that more than half of their daily practice was related to diagnosing and treating incontinence, prolapse, and neurourology. According to 123 participants (80.9%), there was a decrease in outpatient clinics. Diagnostic tests were also reduced, such as uroflowmetry (68.4%) and urodynamics (81.3%). The majority of respondents declared a decrease in elective surgeries as Botox injection (92.1%), surgery for urinary incontinence (93.4%), and surgery for prolapse (85%). Nearly one-quarter of respondents' (28.9%) stated that their diagnostic methods for neurourology patients did not differ. Conclusions: One of the most affected areas in urology during a pandemic is functional urology. Although diagnostic tests and surgery for functional urology are classified as "optional," the quality of life of patients will be affected by the delayed intervention.

Role of diffusion MRI and apparent diffusion coefficient measurement in the diagnosis, staging and pathological classification of bladder tumors.

OBJECTIVES: Our aim was to investigate the role of simultaneous apparent diffusion coefficient (ADC) measurement and diffusion-weighted MRI (DWMRI) in the diagnosis and differentiation of bladder masses. METHODS: We examined 45 patients presenting with hematuria by dynamic and diffusion MRI (at b100, b600, b1000 gradients) and cystoscopy. Thirty healthy volunteers without hematuria were also included in the study. Results from imaging techniques were compared to cystoscopic and histopathologic findings. The ADC values of benign and malignant bladder masses, and bladder tissue in healthy subjects were measured and compared with each other. RESULTS: The mean ADC values of benign (n = 10) and malignant lesions (n = 35) were significantly lower than the mean ADC values of adjacent bladder walls and bladder walls of healthy subjects at all 3 gradients (p < 0.05). However, no significant difference was detected between benign and malignant lesions (p > 0.05). Mean ADC values of invasive tumors were significantly lower than superficial malignancies at b600 and b1000 gradients. The mean ADC values of transitional cell tumors were significantly higher than squamous cell tumors at b100 and b600 gradients. CONCLUSION: Simultaneous measurement ofADC and DWMRI provided useful information in the diagnosis, staging and histopathological classification of bladder tumors.

Effect of focal and diffuse hypervascularization as cystoscopic findings on predicting intravesical therapy response in patients with bladder pain syndrome.

OBJECTIVE: To define the relationship between cystoscopic findings, including novel findings such as the hypervascularization, of bladder pain syndrome/interstitial cystitis (BPS/IC) and the response to intravesical therapy. MATERIAL AND METHODS: We retrospectively evaluated cystoscopy findings in patients who had a preliminary diagnosis of BPS/IC. All patients received early intravesical combined therapy (ICT), ie, within 2 hours after hydrodistention. Additionally, ICT was continued according to our protocol. Cystoscopic findings were classified as glomerulations, hypervascularization, and Hunner's lesion (HL). The therapy responses were evaluated at 1st, 3rd, 6th, and 12thmonths using the visual analog scale (VAS), O'Leary/Sant interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI) scores. RESULTS: Out of 61 patients, HL was diagnosed during cystoscopy in six (9.8%) patients, glomerulations in 35 (57.4%) patients, and hypervascularization in 15 (24.6%) patients. No pathological findings were defined in five (8.2%) patients. In the glomerulation and hypervascularization group, the median VAS, ICSI, and ICPI scores were lower than those in the preoperative period in the follow-up. In patients with HL, the median VAS scores were lower in the entire follow-up compared to the preoperative period, with an increase at 1st year compared to 6th month, and ICSI scores were lower than preoperative period in the entire follow-up, with an increase at 3rd month and 1st year. ICPI scores were also lower during the follow-up, with an increase observed in the 1st year. CONCLUSION: The presence of hypervascularization should be defined since it might show different characteristics that may affect the ICT response. Patients with glomerulations might be good candidates for early combined intravesical therapy.

The Role of Educational Level and Cognitive Status in Men Undergoing Artificial Urinary Sphincter Implantation.

OBJECTIVE: To examine the relationship between education level, cognitive function of patients and the success/ revision rates of artificial urinary sphincter (AUS) implantation in men with postprostatectomy incontinence. METHODS: Between January 2010 and March 2018, 163 patients (mean age, 68 ± 6.8 years) with moderate-to-severe stress urinary incontinence who underwent AUS implantation were retrospectively examined. Demographic data, body mass index, comorbidities, surgical technique, previous strictures, and radiation therapy were recorded. Incontinence was measured by daily pad use and evaluated by International Consultation on Incontinence Questionnaire-short form. Patients' overall improvement was assessed using the Patient Global Impression of Improvement questionnaire. Education level was determined using the International Standard Classification of Education. Cognitive status was assessed using the Mini-Mental State Examination. Treatment success was defined as the need for ≤1 pad/day at last follow-up. RESULTS: AUS was successful in 77.3% of patients. The International Consultation on Incontinence Questionnaire-short form score improved significantly from 19.9 ± 2.9 to 4.4 ± 5.4 (P = .001). The median outcome reported subjectively on the Patient Global Impression of Improvement scale was 2.1 ± 1.5 (1-7) and self-reported as "much better." Patients' education level had statistically no significant relationship with AUS success and revision rates. Similarly, there was no significant relationship between cognitive status, educational level and the need for revision of AUS (P >.05). However, patients with moderate cognitive impairment and a body mass index >30 showed significantly lower AUS success rates (P <.05). CONCLUSION: AUS implantation is safe and effective treatment option especially for nonobese and cognitively intact patients of all educational levels.

Laparoscopic selective pudendal neuromodulation for neurogenic bladder: a review of literature.

This study presents an alternative technique for neuromodulation in cases where percutaneous sacral implantation is difficult or has previously failed. We aimed to describe a novel technique of selective placement of an electrode over the pudendal nerve (PN), via laparoscopic approach in a patient with urinary retention who previously failed sacral neuromodulation (SNM) treatment.

Single-incision midurethral sling shows less pain and similar success rate in a short-term follow-up compared to the transobturator tape method in the treatment of stress urinary incontinence.

OBJECTIVE: To compare the efficacy, complications, quality of life, and patient satisfaction rates in women treated for stress urinary incontinence (SUI) using the adjustable anchored single-incision midurethral sling (SIMS) and standard midurethral sling (MUS) procedures. MATERIAL AND METHODS: A total of 113 women between October 2012 and October 2016 underwent either the adjustable SIMS (n=54) or MUS (n=57) procedure. The postoperative pain profile was assessed using a 10-point visual analog scale at the fixed time-point quality of life and an additional postoperative 3rd week appointment. We asked our patients the following two questions to evaluate their satisfaction with surgery and their preference: "Would you have this kind of surgery again?" (Q1), and "Would you recommend this type of surgery to another patient with same symptoms?" (Q2). For the evaluation of patient complaints, the Incontinence Impact Questionnaire (IIQ-7) and Urinary Distress Inventory (UDI-6) were used before and after the procedure. RESULTS: Women in the SIMS group had a significantly lower postoperative pain profile for up to 3 weeks (p<0.001). There was no significant difference in perioperative complications and postoperative continence rates between the groups. With regard to Q1 and Q2, a significant difference was found between the groups (p=0.003 and p=0.002, respectively). While the questionnaire scores of the IIQ-7 and UDI-6 were also significantly improved at postoperative evaluations (p<0.001), there was no significant difference between the two groups. CONCLUSION: SIMS is associated with a significantly improved postoperative pain profile and earlier return to work when compared to MUS.

Prevalence and risk factors of female urinary incontinence in eastern Turkey.

OBJECTIVES: To evaluate the prevalence of urinary incontinence (UI) and determine risk factors for its development in women living in eastern Turkey. METHODS: A cross-sectional study was conducted on 2275 women aged between 17 and 80 years. A questionnaire examining demographic characteristics, parity and pelvic organ prolapse was given. Presence and types of incontinence were examined using a validated form of the Turkish version of the urogenital distress inventory questionnaire-short form (UDI-6). RESULTS: A total of 1054 (46.3%) women reported involuntary loss of urine. Stress UI was present in 46% of women, whereas urge UI was detected in 43% of them. Mean age of patients with and without UI were 44.57 + 11.04 and 35.04 + 9.51, respectively. Age, total number of pregnancies and number of deliveries were shown to be significantly different in patients with and without any type of UI. Multiple logistic regression analysis of the factors revealed that age, total delivery number, pelvic organ prolapse and difficult labor were significantly associated with the presence of UI. CONCLUSIONS: This is the first study examining the prevalence of UI in women living in eastern Turkey. By using a validated questionnaire, several risk factors for the development of UI were determined. Pelvic organ prolapse and increased number of births were found to be two most significant ones.

Do success rate, complications of transobturator tape procedure differ based on experienced surgeon or residents? / ¿Son diferentes las tasas de éxito y complicaciones de la malla transobturatriz entre cirujanos expertos y residentes?

OBJECTIVES: To investigate the postoperative surgical complications and patient satisfaction with the outside-in transobturator tape (TOT) procedure performed by an experienced surgeon compared to those performed by residents in training. METHODS: Patients who received TOT surgery performed by a resident under supervision of a faculty were included in group 1 (n = 31) whereas, patients operated by the same faculty were included in group 2 (n = 26). Both groups were compared for demographic data, procedure results, satisfaction rates as well as intraoperative and early postoperative (urinary retention, vaginal erosion, dyspareunia, infection, abnormal discharge) complications. Statistical Package for Social Sciences for Windows was used for statistical analyses. For continuous variables Mann-Whitney U test and for categorical variables Chi-square, Fishers exact tests were used. RESULTS: Stress incontinence in groups 1 and 2 were either completely cured or improved in 87.1% and 84.6%, respectively. The question" Would you like to have an operation like this again?" was answered positively by 26 (83.9%) of patients in group 1 and by 22 (84.6%) in group 2. There was no significant difference between two groups for the complication rates occurred within 90-days period. However, there was a significantly higher groin pain persisting more than three weeks in group 1 (38.7%) compared to group 2 patients (7.7%). CONCLUSIONS: There was statistically significant increased groin pain in the early period in TOT procedures performed by the residents. However, the complications observed in both groups did not affect the success rate or patient satisfaction.

OBJETIVOS: Investigar las complicaciones quirúrgicas postoperatorias y la satisfacción del paciente con la operacion de malla transonbturatriz fuera-adentro realizada por un cirujano experto en comparación con la realizada por residentes en formación.MÉTODOS: Las pacientes operadas de TOT por un residente bajo supervisión de un adjunto se incluyeron en el grupo 1 (n = 31) y las operadas por el mismo adjunto se incluyeron en el grupo 2 (n = 26). Se compararon los datos demográficos, resultados de la operación, tasas de satisfacción así como las complicaciones intraoperatorias y postoperatorias tempranas (retención urinaria, erosión vaginal, dispareumia, infeccion, flujo anormal). Para el análisis estadístico se utilizó el software SPSS para Windows. Se utilizaron el test de la U de Mann- Whitney para variables continuas y los de Chi cuadrado y Prueba exacta de Fisher para variables categóricas. RESULTADOS: La incontinencia urinaria de esfuerzo en los grupos 1 y 2 fue bien completamente curada, bien mejoró en 87,1% y 84,6%, respectivamente. La pregunta ¿volvería a someterse a la misma operación? fue respondida positivamente por 26 (83,9%) de los pacientes en el grupo 1 y 22 (84,6%) en el grupo 2. No había diferencias estadísticamente significativas entre los grupos en la tasa de complicaciones en los primeros 90 días. Sin embargo, el dolor en la ingle que persistía más de 3 semanas era significativamente mayor en el grupo 1 (38,7%) en comparación con las pacientes del grupo 2 (7,7%). CONCLUSIONES: Hay un aumento estadisticamente significativo del dolor en el muslo en el periodo postoperatorio temprano de las operaciones de TOT realizadas por residentes. Sin embargo, las complicaciones observadas en ambos grupos no afectaron a la tasa de éxitos o a la satisfaccion del paciente.

Comparison of solvent-dehydrated allograft dermis and autograft rectus fascia for pubovaginal sling: questionnaire-based analysis.

OBJECTIVES: To evaluate the efficacy of pubovaginal sling using human cadaveric dermis processed by solvent dehydration and compare results to those of another group in which autograft rectus fascia was used. MATERIAL AND METHODS: The efficacy of autologous rectus fascia (group 1, n=25) or solvent-dehydrated cadaveric dermis (group 2, n=24) for pubovaginal sling were compared in women with stress urinary incontinence (SUI). Surgical outcome, patient satisfaction and quality of life was assessed by the urogenital distress inventory (UDI-6) and the incontinence impact questionnaire (IIQ-7). RESULTS: Mean follow-up for patients in group 1 and group 2 were 18 and 13 months, respectively. Our questionnaire-based assessment revealed that SUI was either cured or improved in a total of 21 (84%) patients in group 1 and 19 (79%) patients in group 2. No statistically significant difference was found for the overall success (P<0.05) and no major complications were encountered in both groups. CONCLUSIONS: Use of allograft dermis as an alternative to autologous rectus fascia for pubovaginal sling had comparable improvement in patient satisfaction and quality of life at intermediate term.

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

OBJECTIVE: We aimed to review the approaches of urologist and gynecologist in the management of overactive bladder (OAB). MATERIAL AND METHODS: A questionnaire consisting of 12 items were answered by 375 urologist and 46 gynecologist. The differences between frequency of encountering OAB, their viewpoints concerning conservative treatment, and their experience related to anticholinergic drug use and the management of refractory OAB were compared. RESULTS: The majority of the urologists, and gynecologists responded to the question "How often do you encounter OAB patients in your daily practice?" as 'in 10-25, and 50% of our patients', respectively (<0.001). The most common complaint consulted to urologists, and gynecologists were urge incontinence (51.1% vs. 64.8). The frequency of using questionnaire and voiding diary was similar in both specialties (23.9% vs. 25.1%, p=0.892). It was observed that 38.6% of the urologists, and 50% of the gynecologists had recommended conservative treatment as a first-line treatment of overactive bladder (p=0.049). The low sociocultural level was the most important obstacle confronting application of conservative treatment methods (54.3% vs. 37%, p=0.012). The survey participants indicated that the most important factor which affected their decision to select an anticholinergic agent as the first-line treatment of overactive bladder was higher effectiveness of these drugs (urologists; 55.7%, and gynecologists 64%, p=0.371). The patients who started to receive anticholinergic drugs most frequently complained both to their urologists, and/or gynecologists about dry mouth (76.3 vs. 74.5%). Based on the responses of the urologists, and gynecologists, the most frequent reason of anticholinergic drug withdrawal was patients' inability to tolerate side effects of these drugs (48% vs. 47.8%, p=0.697). The participants indicated that in case of unsatisfactory response to one anticholinergic agent, swithching rate to another anticholinergic drug was 56.9% among urologists vs. 59.6%, among gynecologists. In addition, 36.9% of urologists and 38.5% of gynecologists recommended another pharmaceutical form of the drug with a higher dose to their patients (p=0.279). Similar number of physicians indicated that the prescribed anticholinergic drug should be continued for at least 3 months and in case of unresponsiveness patient could be considered refractory. Majority of urologists (68.8%), and gynecologists (56.5%) chose to perform urodynamic tests in patients who are unresponsive to anticholinergic treatment, (p=0.093). CONCLUSION: The attitudes of urologist and gynecologist for diagnosis and treatment of OAB are mostly correlating with current guideline practices with few exceptions. Urologists tend to use bladder diaries or questionnaires less frequently whereas, gynecologists refer to urodynamic studies in patients with refractory OAB less than the urologists do. However, irrespective of the clinical speciality, conservative treatment modalities are rarely administered.

Botulinum toxin injections for treating neurogenic detrusor overactivity.

Neurogenic detrusor overactivity (NDO) is a disorder that can cause high intravesical pressure, decreased capacity, decreased bladder compliance, and upper urinary system damage. The current treatment options for NDO are established on the basis of agents that block parasympathetic innervation of the detrusor and inhibit involuntary bladder contractions. Several side effects, such as dryness of mouth, constipation, dyspepsia, changes in visual accommodation, somnolence, and being unable to obtain consistently favorable results, caused by anticholinergic agents, which are frequently used for this purpose, decrease the patient's compliance to treatment. Procedures such as neuromodulation, auto-augmentation, and enterocystoplasty are surgical options, and they could be used as the last alternative. Thus, botulinum toxin (BTX) injections to the detrusor have been commonly performed in recent years and lead to satisfactory results. The mechanism of action of BTX in NDO is based on the principal of smooth muscle relaxation in the bladder by the transient inhibition of neuromuscular nerve signals. The aim is to decrease acetylcholine secretion by blocking presynaptic vesicles in the neuromuscular junction. When studies were evaluated, it was observed that BTX injections to the detrusor muscle are a necessary and effective option in patients with incontinence caused by NDO. This treatment option could be indicated in situations where anticholinergic agents are not effective or could not be tolerated, and it could be a valuable alternative to major surgical treatments. In this review, we evaluated the effectiveness and reliability of BTX in patients with NDO.

Metabolic syndrome does not impair the response to alfuzosin treatment in men with lower urinary tract symptoms: a double-blind, randomized, placebo-controlled study.

OBJECTIVE: This study is a placebo-controlled comparison of the response to alfuzosin treatment for lower urinary tract symptoms (LUTS) in patients with and without metabolic syndrome (MetS). MATERIAL AND METHODS: A total of 80 men with LUTS were included in the study. Patients had a maximum flow rate of <15 mL/sec, prostate volume of >20 mL, and International Prostate Symptom Score (IPSS) of >8. All eligible men (n=68) for evaluation were initially divided into two groups as MetS (n=34) and non-MetS (n=34) groups. Patients were further randomized to receive alfuzosin (10 mg/day) or placebo (n=17/group; a total of four groups). The outcome was measured at 12(th) week according to the changes from baseline in IPSS, quality of life (QoL) scores, maximum flow rate (Qmax), and postmictional residue. RESULTS: Alfuzosin significantly improved LUTS in men with and without MetS compared with patients receiving placebo (p<0.05). Mean IPSS scores in treatment groups decreased significantly, whereas patients receiving placebo had no statistically significant difference (p>0.05). Similarly, alfuzosin treatment resulted in a significant increase in Qmax in patients with LUTS/benign prostatic enlargement when compared with patients in placebo group (p<0.05). Mean QoL scores measured by IPSS-QoL and QoL questionnaires also improved significantly in patients receiving alfuzosin for 3 months regardless of the presence of MetS (p<0.05). CONCLUSION: Our results revealed that the presence of MetS in patients with LUTS did not impair the response to alfuzosin treatment.

Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder.

OBJECTIVE: To evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS), either alone or combined with an anticholinergic agent, in treating patients with an overactive bladder (OAB) in whom previous conservative treatment failed. MATERIAL AND METHODS: In this study, we included a total of 30 female patients with OAB in whom all conventional therapies failed between January 2010 and April 2011. Patients were randomly divided into three groups: Group 1, PTNS group; Group 2, patients receiving an anticholinergic agent; and Group 3, patients receiving both PTNS and anticholinergic agent. PTNS treatment continued for 12 weeks with each session lasting 30 min. RESULTS: All parameters of the bladder diary significantly improved in all groups (p<0.05). Similarly, all scores measured by questionnaires (UDI-6, IIQ-7, and OABSS) revealed significant improvements in all groups. When the improvements in symptoms were compared among the groups, there was a statistically significantly higher improvement in groups 1 and 3 than in Group 2. CONCLUSION: PTNS is a safe, simple, and minimally invasive treatment modality in patients with OAB, and it may be suggested either alone or in combination with anticholinergics when conventional treatments fail.