Treatment effectiveness in interstitial cystitis/bladder pain syndrome: Do patient perceptions align with efficacy-based guidelines?

INTRODUCTION: We sought to determine if patients' perceptions of success or failure of interstitial cystitis/bladder pain syndrome (IC/BPS) therapies proposed in treatment guidelines align with the evidence from available clinical trial treatment data. METHODS: A total of 1628 adult females with a self-reported diagnosis of IC completed a web-based survey in which patients described their perceived outcomes with the therapies they were exposed to. Previously published literature, used in part to develop IC/BPS guidelines, provided the clinical trial data outcomes. Patient-reported outcomes were compared to available clinical trial outcomes and published treatment guidelines. RESULTS: Based on patient perceived outcomes (benefit:risk ratio), the most effective treatments were opioids, phenazopyridine, and alkalizing agents, with amitriptyline and antihistamines reported as moderately effective. The only surgical procedure with any effectiveness was electrocautery of Hunner's lesions. In order of efficacy reported in the literature, the therapies for IC/BPS with predicted superior outcomes should be: cyclosporine A, amitriptyline, hyperbaric oxygen, pentosan polysulfate plus subcutaneous heparin, botulinum toxin A plus hydrodistension, and L-arginine. While some of the guideline recommendations aligned with patient-reported effectiveness data, there was a general disconnect between guidelines and effectiveness reported in clinical practice. CONCLUSIONS: There is a disconnect between real-world patient perceived effectiveness of IC/BPS treatments compared to the efficacy reported from clinical trial data and subsequent guidelines developed from this efficacy data. Optimal therapy must include the best evidence from clinical research, but should also include real-life clinical practice implementation and effectiveness.

Use of herbal supplements for overactive bladder.

Anticholinergics, specifically antimuscarinic agents, are the most common medications prescribed for overactive bladder (OAB). The most common side effects of these agents are dry mouth and constipation, although other more concerning effects include changes in blood pressure, pulse rate, or heart rhythm when treatment is initiated. Herbal treatments are an increasingly popular alternative for treating OAB. A 2002 survey of US adults aged ≥ 18 years conducted by the Centers for Disease Control and Prevention indicated that 74.6% of those with OAB had used some form of complementary and alternative medicine. The World Health Organization estimates that 80% of the world's population presently uses herbal medicine for some aspect of primary health care. Women were more likely than men to use complementary and alternative medicine. The authors review the most commonly used herbal medications for OAB.

Cost-effectiveness analysis of tension-free vaginal tape vs burch colposuspension for female stress urinary incontinence in the USA.

OBJECTIVE: To compare the cost-effectiveness (CE) of tension-free vaginal tape (TVT) with that of burch colposuspension (BC) for the treatment of female stress urinary incontinence (SUI). MATERIALS AND METHODS: A Markov-chain decision model was created to simulate treatment of SUI with TVT or BC using Treeage Pro 2011 software (Treeage Software Inc., Williamstown, MA, USA). Costing data were obtained from the Medicare Resource-Based Relative Value Scale. Data regarding the success of TVT vs BC were obtained from the peer-reviewed literature, as were corresponding utilities for different continence states. The CE of each procedure was calculated and compared, and sensitivity analyses were performed. RESULTS: At 10-year follow-up, TVT was more cost-effective (CE = $1495/quality-adjusted life year [QALY]) than BC (CE = $1824/QALY). Sensitivity analysis showed that TVT was more cost-effective than BC if the cost of the TVT device was <$3220. If the probability of success after TVT was <42%, then BC became the more cost-effective strategy (CE = $1827/QALY). CONCLUSION: Our study showed that TVT was more cost-effective than BC as a treatment for female SUI. Both cost of TVT device and efficacy of the procedure affect the CE analysis.

The use of synthetic mesh and the management of mesh extrusion in vaginal surgery.

The authors present a review of the literature regarding the management of mesh extrusion in vaginal surgery. As used in traditional surgical techniques, the use of mesh theoretically allows for a broader base of support and eliminates the need to rely on pre-existing weakened fascia. In this article, the different physical properties and types of synthetic mesh used, and their respective advantages and disadvantages in terms of mesh extrusion, are reviewed.

Personal, professional and financial satisfaction among American women urologists.

PURPOSE: Although nearly half of American medical school classes are comprised of women, less than 5% of female medical students enter the surgical subspecialties compared to nearly 20% of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. MATERIALS AND METHODS: A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. RESULTS: Of the 244 women (69%) who responded, 86.8% (211) reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81% (198) said that they would remain in medicine and 91.4% (222) would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006). CONCLUSIONS: Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.

Personal, professional and financial satisfaction among American women urologists

PURPOSE: Although nearly half of American medical school classes are comprised of women, less than 5 percent of female medical students enter the surgical subspecialties compared to nearly 20 percent of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. MATERIALS AND METHODS: A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. RESULTS: Of the 244 women (69 percent) who responded, 86.8 percent (211) reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81 percent (198) said that they would remain in medicine and 91.4 percent (222) would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006). CONCLUSIONS: Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.

Patient perceived outcomes of treatments used for interstitial cystitis.

OBJECTIVES: Interstitial cystitis (IC) is a challenging disease complex. Patients' perception of their outcomes after different treatment modalities may be the best measure of therapeutic efficacy. Our study focused on a large group of women with a diagnosis of IC who reported on perceived outcomes after undergoing invasive and pharmaceutical treatments for their disease. METHODS: Seven hundred fifty patients with a diagnosis of IC completed a computerized survey that queried each patient about their demographics, symptoms, concomitant diagnoses, treatments, and their perceived treatment outcomes. The patients were surveyed on therapies used to treat IC and whether they perceived their condition to be improved, not affected or having deteriorated at a mean follow-up of 6 months. Pearson chi-squared tests were used in the statistical analyses. RESULTS: Invasive and medical therapies were surveyed. The most commonly performed procedures were hydrodistention (61.9%), intravesical therapy (40.1%), and urethral dilatation (26.5%). Of these procedures, 24.4% to 45.3% of patients were improved by these procedures; whereas 27.0% to 49.8% felt no effect and 25.9% to 30.7% worsened. A comparison of the number of patients who improved with those who deteriorated while on medical therapy was found to be significant for all drugs (P <0.001). The majority of patients reported that medications improved their condition, perceptively. CONCLUSIONS: Medical therapy is perceived to be superior to invasive therapy in the treatment of IC. Medication should be considered the first line therapy for IC. Several medications showed a large percentage of patients with improvement in symptoms. These medications were calcium glycerophosphate (Prelief, AkPharma Inc, Pleasantville, NJ), phenazopyridine, and pentosan polysulfate sodium.

Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition.

PURPOSE: The success rate of vesicovaginal fistula repair is improved by tissue interposition. The Martius flap produces reliable results but it has increased morbidity. A peritoneal flap is easily created with minimal morbidity and it can be used for proximal fistulas. We describe our 10-year experience with tissue interposition for transvaginal repair of vesicovaginal fistulas. MATERIALS AND METHODS: From January 1991 to July 2001, 207 cases of vesicovaginal fistulas were repaired transvaginally. Tissue interposition was used for complex (greater than 2 cm. and/or radiation induced) fistulas and/or failed previous repairs. A peritoneal flap was used for proximal fistulas and a Martius flap was used for distal fistulas. A full-thickness labial flap was reserved for cases of insufficient vaginal epithelium. RESULTS: A total of 207 patients underwent transvaginal repair of a vesicovaginal fistula. Etiology of the fistula was hysterectomy in 91% of cases (abdominal in 83% and vaginal in 8%), radiation in 4% and 5% other (obstetric trauma, anterior colporrhaphy or an indwelling catheter) in 5%. In 159 patients (77%) at least 1 previous repair had failed. Repair in 120 patients (58%) was done with tissue interposition, including a peritoneal, Martius and full-thickness labial flap in 83, 34 and 3, respectively. The cure rate after initial repair with a peritoneal, Martius and labial flap was 96%, 97% and 33%, respectively. There were no intraoperative complications. CONCLUSIONS: A peritoneal flap for transvaginal repair of vesicovaginal fistulas has minimal morbidity, results in a success rate comparable to that of the Martius flap and is especially useful for proximal fistulas when previous repair has failed.