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Tabakin AL, Choi S, Sandozi A, Aibel K, Weintraub MA, Winkler HA, Shalom DF, Tam J, Lee W. Third-Line Overactive Bladder Therapies on TikTok: What Does the Public Learn? UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:557-563. [PMID: 38118059 DOI: 10.1097/spv.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
IMPORTANCE Millions of people rely on social media platforms, including TikTok, for health-related information. TikTok has not yet been evaluated as an information source for overactive bladder (OAB) third-line therapies. OBJECTIVES Our aim was to assess TikTok videos on third-line therapies for OAB for misinformation and quality. STUDY DESIGN In this cross-sectional analysis, we abstracted the top 50 TikTok videos for keywords: "Axonics," "sacral neuromodulation," "Interstim," "PTNS," "posterior tibial nerve stimulation," and "bladder Botox." Videos were scored for quality by 3 independent reviewers using the Medical Quality Video Evaluation Tool (MQ-VET). Two reviewers determined if videos contained misinformation. RESULTS Of 300 videos screened, 119 videos were included. Twenty-four (21%) were created by medical professionals (MPs). Medical professional videos were more frequently shared (5 vs 1, P < 0.01) but had similar views, likes, comments, and length. Although MP videos had significantly higher MQ-VET scores (43 vs 27, P < 0.01), there was no difference in the rate of misinformation between MP and non-MP videos (21% vs 18%). Twenty-two videos (18.4%) contained misinformation, which were 3 times longer (50.5 vs 15 seconds, P < 0.01) and had higher MQ-VET scores (34.5 vs 27, P = 0.03) than those without misinformation. Common themes of misinformation pertained to therapy indication, mechanism of action, and patient limitations after undergoing therapy. CONCLUSIONS Many TikTok videos on OAB third-line therapies contain misinformation. Most of these videos were not of high quality and created by the public. Medical professionals should be aware of misinformation permeating TikTok, given its large audience, and aim to promote or offer educational material of better accuracy and quality.
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Affiliation(s)
- Alexandra L Tabakin
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Sharon Choi
- The Smith Institute for Urology at Northwell Health, New Hyde Park
| | - Arshia Sandozi
- Department of Urology, Maimonides Medical Center, Brooklyn
| | - Kelli Aibel
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | | | - Harvey A Winkler
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Dara F Shalom
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Justina Tam
- Department of Urology, Stony Brook University Hospital, Stony Brook, NY
| | - Wai Lee
- The Smith Institute for Urology at Northwell Health, New Hyde Park
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Selle JM, Hanson KT, Habermann EB, Gebhart JB, Trabuco EC, Occhino JA, Young AD, Linder BJ. The Impact of an Overactive Bladder Care Pathway on Longitudinal Patient Management. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:330-336. [PMID: 38484250 DOI: 10.1097/spv.0000000000001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Implementation of an overactive bladder (OAB) care pathway may affect treatment patterns and progression. OBJECTIVES This study aimed to assess the effect of OAB care pathway implementation on treatment patterns for women with OAB. STUDY DESIGN This retrospective cohort study evaluated women with OAB, before (January 1, 2015-December 31, 2017) and after (January 1, 2019-December 31, 2021) care pathway initiation. Care pathway use included standardized counseling, early introduction of therapy, and close follow-up. Primary outcomes included OAB medication use, follow-up visits, third-line therapy, and time to third-line therapy. RESULTS A total of 1,349 women were included: 1,194 before care pathway implementation and 155 after. Patients after implementation were more likely to have diabetes mellitus (P = 0.04) and less likely to smoke (P = 0.01). Those managed via a care pathway were more likely to use any medication or third-line therapy within 1 year after consultation (61.3% vs 25.0%; P < 0.001). This included higher proportions receiving a medication (50.3% [95% confidence interval (CI), 41.8%-57.6%] vs 23.3% [95% CI, 20.9%-25.7%]; P < 0.001) and progressing to third-line therapy (22.6% [95% CI, 15.7%-28.9%] vs 2.9% [95% CI, 2%-3.9%]; P < 0.001). Among those who underwent third-line treatment, care pathway use was associated with shorter time to third-line therapy (median, 10 days [interquartile range, 1-56 days] vs 29 days [interquartile range, 7-191 days]; P = 0.013). Those managed via a care pathway were less likely to have additional clinic visits for OAB within 1 year after initial consultation (12.3% vs 23.9%; P < 0.001). CONCLUSIONS Use of an OAB care pathway was associated with higher rates of oral medication and third-line therapy yet decreased follow-up office visits. Use of an OAB care pathway may promote consistent and efficient care for women with OAB.
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Affiliation(s)
| | - Kristine T Hanson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
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Sitto HM, Brodsky CN, Wittmann D, Wallner LP, Streur C, DeJonckheere M, Stoffel JS, Cameron AP, Sarma A, Clemens JQ, Ippolito GM. Patient and physician decision-making dynamics in overactive bladder care: A mixed methods study. Neurourol Urodyn 2024; 43:565-573. [PMID: 38334205 PMCID: PMC11054369 DOI: 10.1002/nau.25416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
AIMS Overactive bladder management includes multiple therapeutic options with comparable efficacy but a range of administration modalities and side effects, creating an ideal setting for shared decision-making. This study investigates patient and physician health beliefs surrounding decision-making and expectations for overactive bladder with the aim of better understanding and ultimately improving decision-making in overactive bladder care. METHODS Patient and physician participants completed a questionnaire followed by a semi-structured interview to assess health beliefs surrounding decision making and expectations for overactive bladder treatment. The semi-structured interview guide, developed in an iterative fashion by the authors, probed qualities of overactive bladder therapies patients and physicians valued, their process of treatment selection, and their experiences with therapies. RESULTS Patients (n = 20) frequently cited treatment invasiveness, efficacy, and safety as the most important qualities that influenced their decision when selecting overactive bladder therapy. Physicians (n = 12) frequently cited safety/contraindications, convenience, cost/insurance, and patient preference as the most important qualities. In our integration analysis, we identified four key themes associated with decision making in overactive bladder care: frustration with inaccessibility of overactive bladder treatments, discordant perception of patient education, diverging acceptability of expected outcomes, and lack of insight into other parties' decisional priorities and control preferences. CONCLUSIONS While both patients and physicians desire to engage in a shared decision-making process when selecting therapies for overactive bladder, this process is challenged by significant divergence between patient and physician viewpoint across key domains.
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Affiliation(s)
| | | | | | | | - Courtney Streur
- University of Michigan, Department of Urology, Ann Arbor, MI
| | | | - John S. Stoffel
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Anne P. Cameron
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Aruna Sarma
- University of Michigan, Department of Urology, Ann Arbor, MI
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Lee UJ, Xavier K, Benson K, Burgess K, Harris-Hicks JE, Simon R, Proctor JG, Bittner KC, Stolen KQ, Irwin CP, Offutt SJ, Miller AE, Michaud EM, Falkner PC, Coetzee JC. Rationale and design of an implant procedure and pivotal study to evaluate safety and effectiveness of Medtronic's tibial neuromodulation device. Contemp Clin Trials Commun 2023; 35:101198. [PMID: 37691849 PMCID: PMC10491630 DOI: 10.1016/j.conctc.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023] Open
Abstract
Percutaneous tibial neuromodulation is a medical guideline recommended therapy for treating symptoms of overactive bladder. Stimulation is delivered to the tibial nerve via a thin needle placed percutaneously for 30 min once a week for 12-weeks, and monthly thereafter. Studies have shown that this therapy can effectively relieve symptoms of overactive bladder; however, the frequent office visits present a barrier to patients and can impact therapy effectiveness. To mitigate the burden of frequent clinic visits, small implantable devices are being developed to deliver tibial neuromodulation. These devices are implanted during a single minimally invasive procedure and deliver stimulation intermittently, similar to percutaneous tibial neuromodulation. Here, we describe the implant procedure and design of a pivotal study evaluating the safety and effectiveness for an implantable tibial neuromodulation device. The Evaluation of Implantable Tibial Neuromodulation (TITAN 2) pivotal study is a prospective, multicenter, investigational device exemption study being conducted at up to 30 sites in the United States and enrolling subjects with symptoms of overactive bladder.
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Affiliation(s)
- Una J. Lee
- Virginia Mason Medical Center, Seattle, WA, USA
| | - Keith Xavier
- Urology Partners of North Texas, Arlington, TX, USA
| | - Kevin Benson
- Sanford Female Pelvic Medicine Reconstructive Surgery Clinic, Sioux Falls, SD, USA
| | | | | | - Robert Simon
- Urologic Research and Consulting, Englewood, NJ, USA
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Robinson D, O’Kane M, Cardozo L. Adherence to Overactive Bladder Syndrome Treatments Recent Developments and Future Perspectives. Int J Womens Health 2023; 15:799-811. [PMID: 37251090 PMCID: PMC10224686 DOI: 10.2147/ijwh.s369588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Overactive bladder (OAB) is a common and distressing condition which is known to have a significant effect on Health-Related Quality of Life (HRQoL). Whilst all patients complaining of overactive bladder symptoms will, in theory, initially benefit from conservative measures, many will require pharmacological therapy. Antimuscarinics currently remain the most commonly used drugs to treat OAB although compliance and persistence can be poor due to concerns regarding adverse events and lack of efficacy. This review will explore the common management strategies for OAB with a particular focus on patient adherence to therapy including compliance and persistence. The role of antimuscarinics and the B3-agonist, mirabegron, will be considered along with barriers to their efficacy and adoption. For those patients in whom conservative and pharmacological treatment proves ineffective or is unsuitable, the management of refractory OAB will also be considered. In addition, the role of current and future developments will be examined.
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Affiliation(s)
- Dudley Robinson
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Miriam O’Kane
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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Speed J, Welk B, Comiter C, Elliott C. Determining patient preferences in the treatment of medication-refractory overactive bladder. Neurourol Urodyn 2023; 42:419-426. [PMID: 36480150 DOI: 10.1002/nau.25109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is often suboptimally addressed by behavioral or pharmacological treatments. Less than 15% of patients choose to pursue advanced OAB therapy (sacral nerve stimulation [SNS], percutaneous tibial nerve stimulation [PTNS], and bladder onabotulinum toxin type-A [BTX-A]). We seek to better understand which factors are most important to patients when choosing a third-line therapy. METHODS/MATERIALS We developed a conjoint analysis survey that included five attributes of the third-line options for OAB (SNS, PTNS, and BTX-A). We administered the survey to new patients with urinary incontinence at two institutions. A hierarchical Bayes random effects regression analysis was used to determine the relative importance of the attributes. A choice simulator was used to model which third-line treatment options patients preferred. We followed patients to see if they pursued their predicted treatment. RESULTS A total of 108 patients completed the study of whom 89% were women. There was representation from all age groups. The most important attributes of decision-making were the frequency of future procedures, the risk of catheterization, and the need for a device. On market simulation, SNS was the preferred treatment option (47%), followed by PTNS (29%) and BTX-A (14%). Only 10% of patients did not find any treatment option acceptable. CONCLUSIONS Frequent follow-up, risk of catheterization, and the need for a device were the most important attributes when making a decision on third-line OAB therapy. On market simulation, SNS is the preferred treatment for all age groups though the ultimate choice in third-line therapy may be affected by external factors.
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Affiliation(s)
- Jacqueline Speed
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Department of Surgery, North Shore Physicians Group, Salem, Massachusetts, USA
| | - Blayne Welk
- Department of Surgery, St. Joseph's Hospital, London, Ontario, Canada
| | - Craig Comiter
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher Elliott
- Department of Urology, Santa Clara Valley Medical Center, Santa Clara, California, USA
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MacNevin W, Bitcon C, Cox A. Social Disparities in the Diagnosis and Care of Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Ng Hung Shin PB, Rhee H, Chung E. Trends in minimally invasive surgical therapies for overactive bladder management in Australia. Low Urin Tract Symptoms 2022; 14:427-433. [PMID: 36098437 DOI: 10.1111/luts.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the national trends in minimally invasive surgical therapies (MIST) for overactive bladder (OAB) in Australia over the past decade. METHODS Annual MIST data were extracted using the Australian Medicare Benefit Schedule (MBS) on intravesical botulinum toxin (BTX), sacral nerve modulators (SNM) and percutaneous tibial nerve stimulators (PTNS) performed between 2010 and 2021. Population-adjusted rates of these procedures were compared in relation to individual states and against the introduction of various OAB drugs during the intervening years. RESULTS The overall national utilization of MIST for OAB has increased over the last decade. The data reflect a rapid uptake in PTNS over the last 2 years following its introduction compared to the relatively steady increase in BTX and SNM over the past decade. There was minimal difference in SNM lead and generator placement, suggesting perhaps the conversion of trial SNM to permanent SNM has been relatively stable across the years. In contrast, there was an increase in PTNS maintenance in the following years following the initial rise in the PTNS treatment initiation. The introduction of various OAB drugs in the market did not seem to significantly affect the pattern of MIST uptake. CONCLUSION Despite the introduction of various OAB drugs, the overall MIST has increased steadily over the last decade, especially with PTNS. Further exploration into the motivators for specific MIST and cost-benefit analysis of these MIST for OAB is warranted.
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Affiliation(s)
- Paul Brian Ng Hung Shin
- The University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Handoo Rhee
- The University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Eric Chung
- The University of Queensland, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Davidson ER, Miceli L, Propst K. Why Patients Fall Through the Cracks: Assessment of Patients' Overactive Bladder Treatment. J Womens Health (Larchmt) 2022; 31:1314-1319. [PMID: 35363051 PMCID: PMC9527055 DOI: 10.1089/jwh.2021.0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Despite an established treatment algorithm for overactive bladder (OAB), it is unclear how many patients proceed through each step. Our objective was to evaluate the percentage of patients receiving each step of care and identify reasons why patients did not receive certain treatments. Methods: This was a retrospective cohort study with cross-sectional survey of new OAB patients. The medical record was queried for relevant patient characteristics and documentation of conservative, medical, and third-line therapies. In the survey, patients were asked about current bladder symptoms and reasons why they did not use certain treatments. Descriptive statistics were used for analysis. Results: One hundred eleven patients met the inclusion criteria; the most common diagnosis was mixed incontinence (40%, n = 45). The median number of visits for OAB was 2 (range 1-8). On retrospective analysis, 64% (71) of patients had documented attempts at conservative therapy. Seventy-six percent (84) of patients attempted medical therapy, and only 11% (12) progressed to any third-line therapy. Fifty-nine percent (64) of eligible patients responded to the survey. Fifty-three percent (34) of respondents reported persistent moderate to very severe bother due to bladder symptoms. Thirty percent to fifty percent of patients who did not attempt one or more of the three levels of OAB therapy reported that they were never offered that treatment option. Conclusions: Many patients do not progress to the next steps in OAB therapy despite failure of more conservative treatments. Barriers to care included limited follow-up and education about other therapy options. A formalized institutional care pathway may lead to improved OAB treatment.
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Affiliation(s)
- Emily R.W. Davidson
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lia Miceli
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Katie Propst
- Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Enemchukwu EA, Subak LL, Markland A. Barriers and facilitators to overactive bladder therapy adherence. Neurourol Urodyn 2022; 41:1983-1992. [PMID: 35510540 DOI: 10.1002/nau.24936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 12/25/2022]
Abstract
AIMS To provide an overview of the barriers and facilitators to overactive bladder (OAB) therapy initiation and adherence. METHODS A PubMed and Embase literature search was conducted to identify barriers to OAB therapy adherence. RESULTS OAB therapy adherence is associated with improvements in urinary symptoms, and quality of life with reductions in annual costs for OAB-related expenditures. However, adherence rates to behavioral therapies are as low as 32% at 1 year, only 15%-40% of treated patients remain on oral medications at 1 year due to several factors (e.g., inadequate efficacy, tolerability, and cost), and 5%-10% of OAB patients progress to advanced therapies. While some common barriers to therapy adherence are often fixed (e.g., costs, lack of efficacy, time, side effects, treatment fatigue), many are modifiable (e.g., lack of knowledge, poor relationships, negative experiences, poor communication with providers). Patient-centered care may help address some modifiable barriers. Emerging data demonstrate that patient-centered care in the form of treatment navigators improves OAB therapy adherence and progression to advanced therapies in the appropriate patient. CONCLUSIONS There are numerous modifiable barriers to OAB therapy adherence. A patient-centered lens is needed to elicit patient goals, establish realistic treatment expectations, and tailor therapy to improve therapy adherence, optimize outcomes, and reduce healthcare expenditures. Further research is needed to develop and study low-cost, scalable solutions.
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Affiliation(s)
- Ekene A Enemchukwu
- Department of Urology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Leslee L Subak
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Alayne Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Soda T, Koike S, Ikeuchi R, Okada T. Utilization rate and long-term persistence of combination pharmacotherapy with β3-agonists and antimuscarinics for overactive bladder refractory to monotherapy in a real-world setting. Neurourol Urodyn 2022; 41:1165-1171. [PMID: 35419862 DOI: 10.1002/nau.24935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 11/07/2022]
Abstract
AIM To assess real-world treatment profiles, including utilization rate, time to and reasons for discontinuation of combination pharmacotherapy with β3 -agonists and antimuscarinics for refractory overactive bladder (OAB) through a retrospective chart review. METHODS We retrospectively reviewed the records of OAB patients who received β3 -agonists or antimuscarinics at our hospital between 2012 and 2020 and analyzed the clinical course of patients who progressed to combination therapy. Data on age, sex, major complaints, OAB symptom score at the initiation of combination therapy, treatment persistence, and reasons for discontinuation were collected. Treatment persistence was assessed with respect to the median time to discontinuation and persistence rate at 12 months. RESULTS Of the 2163 patients receiving β3 -agonists or antimuscarinics, only 84 (3.8%) progressed to combination therapy with both drug classes. At therapy initiation, most (98%) of these patients had moderate to severe OAB symptoms. Median treatment duration and 12-month persistence rate for combination therapy were 595 days and 64.0%, respectively. The reasons for discontinuation were insufficient treatment efficacy followed by adverse effects including voiding impairment in nearly 10% of the patients. None of the baseline parameters was independently associated with persistence in the multivariate analysis. CONCLUSION While underutilized among OAB patients refractory to monotherapy, combination pharmacotherapy showed a greater persistence rate than published mirabegron or antimuscarinic monotherapy when applied to patients with moderate to severe symptoms. Treatment-emergent voiding impairment is a concern associated with this mode of therapy. A small sample size at a single institution is the limitation of this study.
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Affiliation(s)
- Takeshi Soda
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Shuhei Koike
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Ryosuke Ikeuchi
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Takuya Okada
- Department of Urology, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
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12
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Burton CS, Gonzalez G, Choi E, Bresee C, Nuckols TK, Eilber KS, Wenger NS, Anger JT. The Impact of Provider Sex and Experience on the Quality of Care Provided for Women with Urinary Incontinence. Am J Med 2022; 135:524-530.e1. [PMID: 34861198 PMCID: PMC9261287 DOI: 10.1016/j.amjmed.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although specialists are skilled in the management of urinary incontinence, primary care clinicians are integral in early diagnosis and initiation of management in order to decrease overuse of specialty care and improve the quality of specialist visits. We measured the quality of incontinence care provided by primary care clinicians prior to referral to a specialist and evaluated the impact of provider variables on quality of care. METHODS We performed a retrospective review of 200 women referred for urinary incontinence to a Female Pelvic Medicine and Reconstructive Surgery specialist between March 2017 and July 2018. We measured primary care adherence to 12 quality indicators in the 12 months prior to specialist consultation. We stratified adherence to quality indicators by clinician sex and years of experience. RESULTS Half of women with incontinence underwent a pelvic examination or had a urinalysis ordered. Few patients with urge urinary incontinence were recommended behavioral therapy (14%) or prescribed medication (8%). When total aggregate scores were compared, female clinicians performed the recommended care 47% ± 25% of the time, compared with 35% ± 23% for male clinicians (P = .003). Increasing years of experience was associated with worse overall urinary incontinence care (r -0.157, P = .02). CONCLUSIONS We found low rates of adherence to a set of quality indicators for women with urinary incontinence, with male clinicians performing significantly worse than female clinicians. Improvement of incontinence care in primary care could significantly reduce costs of care and preserve outcomes.
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Affiliation(s)
- Claire S Burton
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | | | - Eunice Choi
- Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, Calif
| | - Catherine Bresee
- Biostatistics Core, Cedars Sinai Medical Center, Los Angeles, Calif
| | - Teryl K Nuckols
- Division of General Internal Medicine, Cedars Sinai Medical Center, Los Angeles, Calif
| | - Karyn S Eilber
- Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, Calif
| | - Neil S Wenger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, Calif
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Changes in the Patient-Reported Outcomes Measurement Information System (PROMIS) scores following sacral neuromodulation for lower urinary tract symptoms. Curr Urol 2022. [DOI: 10.1097/cu9.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sripad AA, Raker CA, Sung VW. Overactive bladder medication: Anticholinergics versus mirabegron by specialty. Urologia 2022; 89:511-516. [PMID: 35195050 DOI: 10.1177/03915603221076949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The primary aim of this study was to identify high prescribing specialties of overactive bladder (OAB) medications for Medicare Part D beneficiaries, and describe prescribing trends by specialty from 2013 to 2017. The secondary aim was to compare the proportion of medication claims by medication class in each specialty. METHODS We used the Medicare Part D Provider Public Use File to identify the four highest prescribing specialties from 2013 to 2017. We then compared patterns of OAB medication prescription for beneficiaries over 65 years of age between specialties. The number of medication claims, cost, and region were considered. OAB medications were classified as anticholinergic or mirabegron for additional comparison. The primary outcome was the number of OAB medication claims, and the secondary outcome was the proportion of mirabegron claims of all medication claims. RESULTS Primary care providers (PCPs), urology, obstetrics and gynecology (OB/GYNs), and other specialties prescribed the most OAB medications. Total claims increased from 4.06 million in 2013 to 4.51 million in 2017. Mirabegron increased from 65,520 to 892,996 claims. PCPs prescribed the most OAB medications. Urologists had the highest proportion of mirabegron prescribing (19.6%), with an increased odds of mirabegron prescribing compared to OBGYNs (aOR 1.18, 95% CI 1.16-1.19). Compared to OBGYNs, PCPs, and other specialties demonstrated decreased odds of prescribing mirabegron (aOR 0.92 with 95% CI 0.91-0.93, and aOR 0.90 with 95% CI 0.88-0.91, respectively). CONCLUSION In Medicare Part D beneficiaries, PCPs prescribed the most OAB medications between 2013 and 2017. Urologists were most likely to prescribe mirabegron.
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Affiliation(s)
- Abhishek A Sripad
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christina A Raker
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Vivian W Sung
- Division of Urogynecology, Department of Obstetrics & Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
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Gerig N, Cameron T, Arora S, Spear J, Lescozec L, Zhang M. Do we need more patient-friendly treatment options for overactive bladder (OAB)? Neurourol Urodyn 2021; 40:1433-1440. [PMID: 34153139 PMCID: PMC8362122 DOI: 10.1002/nau.24731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/08/2022]
Abstract
Aims To collect feedback from subjects diagnosed with overactive bladder (OAB) on its impact on their quality of life, their satisfaction with current treatment options, and to assess nonsurgical, tibial nerve stimulation as a treatment option. Methods Subjects were asked a variety of questions about the impact of OAB on their lives, their satisfaction with current and previous treatment approaches. Subjects evaluated the comfort of a nonworking prototype garment and were given electrical stimulation over their posterior tibial nerve to assess comfort and tolerability. Electromyographic (EMG) signals were recorded. Results A total of 40 subjects with OAB symptoms were evaluated in the study. Urgency (55%), frequency (47.5%), nocturia (40%), and incontinence (30%) were the most bothersome symptoms. At the time of the study only 32.5% of the subjects were treating their OAB symptoms. Of those that had tried and discontinued treatments, most had failed medications (n = 14) due to no improvements or side effects. Only 2 subjects found stimulation to be uncomfortable before an EMG signal could be detected. The most common word used to describe the feeling of stimulation was “constant,” followed by “tingling,” “vibrating,” and “comfortable.” Conclusions Most subjects who had tried OAB treatments were dissatisfied and discontinued their use. A new patient‐friendly approach to OAB therapy that delivers efficacy but overcomes drawbacks associated with currently available treatments is needed. Subjects found electrical stimulation over the tibial nerve to be comfortable and tolerable and this should be considered as an alternative treatment approach for OAB.
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Affiliation(s)
- Nel Gerig
- The Pelvic Solutions Center, Denver, Colorado, USA
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16
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Rogers A, Sen SK. Placement of a coin-sized implantable tibial neurostimulator (eCoin device) for urgency urinary incontinence. UROLOGY VIDEO JOURNAL 2021. [DOI: 10.1016/j.urolvj.2021.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Woll A, Edenfield A, Locke M, Swift S. Treatment outcomes of overactive bladder with combined therapies of botulinum toxin injections and oral agents. Int Urogynecol J 2021; 32:2803-2806. [PMID: 33620537 DOI: 10.1007/s00192-021-04676-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Treatment options for refractory overactive bladder (OAB) following behavioral modifications and oral OAB medications remain limited. Up to 33% of women fail botulinum toxin injections (Amundsen et al. Eur Urol. 74(1):66-73, 7). This study evaluates the effectiveness of combining oral OAB agents with botulinum toxin in subjects who failed botulinum toxin therapy alone. METHODS This is a retrospective observational study. Eligible women were those who received botulinum toxin injections for OAB between 2013 and 2018 at one academic institution. Women were given the option of oral medications as add-back therapy following failed treatment with botulinum toxin alone. Treatment response was a subjective outcome, with subjects reporting being satisfied or unsatisfied. The primary outcome was the proportion of subjects who achieved satisfactory treatment response with the combination of oral OAB medications and botulinum toxin injections. A subanalysis was performed to further investigate any risk factors associated with poor response to combination treatment. Variables were analyzed using chi-squared or Fisher's exact test and Student's t-test or Mann-Whitney U when appropriate. RESULTS A total of 107 charts were reviewed. Forty-five (48%) women failed botulinum toxin alone as a treatment; 26 (29%) elected to try one or more oral OAB medications. Of the 26 women who received the combination treatment, 17 (65%) reported satisfaction and 9 (35%) remained unsatisfied. Risk factors associated with treatment failure were not identified. CONCLUSION This is an initial report on adding back oral OAB meds to patients who have failed botulinum toxin injections suggesting there may be a role for add-back oral OAB medications.
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Affiliation(s)
- Abbigail Woll
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Suite 635B 96 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | - Autumn Edenfield
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Suite 635B 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Mallory Locke
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Suite 635B 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Steven Swift
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Suite 635B 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
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National Patterns of Filled Prescriptions and Third-Line Treatment Utilization for Privately Insured Women With Overactive Bladder. Female Pelvic Med Reconstr Surg 2021; 27:e261-e266. [PMID: 31157717 DOI: 10.1097/spv.0000000000000744] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate national patterns of care for women with overactive bladder (OAB) in an administrative data set and identify potential areas for improvement. METHODS We performed an analysis using the OptumLabs Data Warehouse, which contains deidentified administrative claims data from a large national US health insurance plan. The study included women, older than 18 years, with a new OAB diagnosis from January 1, 2007, to June 30, 2017. We excluded those with an underlying neurologic etiology, with interstitial cystitis/painful bladder syndrome, were pregnant, or did not have continuous enrollment for 12 months before and after OAB diagnosis. Trends in management were assessed via the Cochran-Armitage test. Time to discontinuation among medications was compared using t test. RESULTS Of 1.4 million women in the database during the study time frame, 60,246 (4%) were included in the study. Median age was 61 years [interquartile range (IQR), 50-73], and median follow-up was 2.6 years (IQR, 1.6-4.2). Overall, 37% were treated with anticholinergics, 5% with beta-3 agonists, 7% with topical estrogen, and 2% with pelvic floor physical therapy; 26% saw a specialist; and 2% underwent third-line therapy. Median time to cessation of prescription filling was longer for beta-3 agonists versus anticholinergics [median, 4.1 months (IQR, 1-15) vs 3.6 months (IQR, 1-10); P < 0.0001]. Use of third-line therapies significantly increased over the study time frame, from 1.1% to 2.2% (P < 0.0001). CONCLUSIONS Most of the patients do not continue filling prescriptions for OAB medications, and a minority of patients were referred for specialty evaluation. Although third-line therapy use is increasing, it is used in a small proportion of women with OAB. Given these patterns, there may be underutilization of specialist referral and other OAB therapies.
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van Vuuren AJ, van Rensburg JA, Jacobs L, Hanekom S. Exploring literature on knowledge, attitudes, beliefs and practices towards urinary incontinence management: a scoping review. Int Urogynecol J 2021; 32:485-499. [PMID: 33404801 DOI: 10.1007/s00192-020-04628-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
| | - J A van Rensburg
- Department of Obstetrics and Gynaecology, Urogynaecology Unit, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Lonese Jacobs
- Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Susan Hanekom
- Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Du C, Berg WT, Siegal AR, Huang Z, Nguyen A, Cheung A, Mehraban-Far S, Anderson R, Jacob S, Kim J. A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies? Neurourol Urodyn 2020; 40:391-396. [PMID: 33197059 DOI: 10.1002/nau.24573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 11/11/2022]
Abstract
AIMS Third-line therapies are efficacious in improving overactive bladder (OAB) symptoms; however, OAB patients have poor follow-up and rarely progress to these therapies. Clinical care pathways (CCP) may improve OAB follow-up rates and third-line therapy use. We sought to determine how new OAB patients follow up and utilize third-line therapies with the implementation of an OAB CCP in a fellowship Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained urologist's academic practice. METHODS We identified new OAB patients using ICD-9 and 10 codes. They were placed into two groups: pre- and post-CCP use. Basic demographic data were collected. Patients were evaluated in a retrospective longitudinal fashion over 12 months to determine follow-up and third-line therapy utilization. RESULTS A total of 769 new OAB patients (261 pre-CCP and 508 post-CCP) were identified. The mean number of follow-up visits increased significantly at 6 months (0.94 vs. 1.64 visits, p = .001) and 12 months (1.26 vs. 2.46 visits, p < .003). Follow-up rates increased significantly at 3 months (38.7% vs. 50.2%, p = .002). Mean time to third-line therapy decreased significantly (280 days vs. 160 days, p = .016). Third-line therapy utilization therapy rates increased at 6 months (7.7% vs. 13.4%, p = .018) and at 12 months (11.1% vs. 16.5%, p = .044). CONCLUSIONS New OAB patients follow-up and progress to third-line therapies faster and more frequently with the use of a CCP in an FPMRS-trained urologist practice. However, many OAB patients still fail to follow up and overall utilization of third-line therapies remains low. Future studies are warranted to identify factors to why overall OAB compliance remains low.
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Affiliation(s)
- Chris Du
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - William T Berg
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Alexandra R Siegal
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Zhenyue Huang
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Anh Nguyen
- Division of Urology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Alice Cheung
- Division of Urology, Albany Medical College, Albany, New York, USA
| | - Sina Mehraban-Far
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Rebecca Anderson
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Sophia Jacob
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Jason Kim
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
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Soda T, Tashiro Y, Koike S, Ikeuchi R, Okada T. Overactive bladder medication: Persistence, drug switching, and reinitiation. Neurourol Urodyn 2020; 39:2527-2534. [PMID: 32985716 DOI: 10.1002/nau.24527] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
AIM To assess real-world treatment profiles, including the time to and reasons for discontinuation or drug switching, treatment reinitiation, and postdiscontinuation follow-up in patients receiving antimuscarinics or ß3-agonists for overactive bladder (OAB) through a retrospective chart review. METHODS We retrospectively reviewed medical charts of 777 patients, aged ≥18 years, who underwent antimuscarinic or ß3-agonist therapy at our hospital. Data on patient's age, sex, chief complaint, and OAB symptom score at therapy initiation were collected. Treatment persistence was assessed with respect to the median time to discontinuation and the persistence rate at 12 months. RESULTS Older patients, male patients, and those with more severe urgency symptoms were more likely to show treatment persistence with OAB medications. Treatment persistence with mirabegron was significantly longer than that with antimuscarinics when administered as either the first- or second-line medication. Multivariate analyses showed that urgency severity and use of mirabegron were independently associated with better persistence (p = .026 and p = .018, respectively). Out of 583 patients who discontinued medication, 344 continued with the visit schedule, and the reinitiation rate of the OAB medication was 19% at a median follow-up of 24 months. CONCLUSION Although the persistence rates for OAB medications improved with the introduction of mirabegron, most patients still discontinued the medication therapy within 1 year. The treatment strategies for patients with mild symptoms and those who are resistant to medication can still be improved. Tailored individualized treatments that avoid excessive reliance on pharmacotherapy would be key to further improve treatment outcomes in OAB patients.
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Affiliation(s)
- Takeshi Soda
- Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Yu Tashiro
- Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Shuhei Koike
- Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Ryosuke Ikeuchi
- Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takuya Okada
- Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
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The Role of Urodynamic Testing Prior to Third-Line OAB Therapy. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Syan R, Zhang CA, Enemchukwu EA. Racial and Socioeconomic Factors Influence Utilization of Advanced Therapies in Commercially Insured OAB Patients: An Analysis of Over 800,000 OAB Patients. Urology 2020; 142:81-86. [PMID: 32439551 DOI: 10.1016/j.urology.2020.04.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/30/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if racial and/or socioeconomic factors influence advanced therapy utilization for refractory overactive bladder (OAB) among the commercially insured. METHODS We queried Optum, a national claims database, between 2003 and 2017. Non-neurogenic OAB patients were identified using ICD-9/10 diagnosis codes. Demographic and treatment data were collected, including oral medication therapies (anticholinergic, beta3 agonists), and advanced therapies (OnabotulinumtoxinA [BTX], Sacral Nerve Stimulation [SNS], percutaneous tibial nerve stimulation [PTNS]). Associations between patient sociodemographic factors and advanced therapy utilization were explored. RESULTS Of 4,229,617 OAB patients, 807,612 (19%) received medical therapies, of which 95% received oral medications only and only 4.7% received advanced therapies. Asians had the lowest use of oral therapy use (14% vs 18%-19% in other races/ethnicities, P <0.05), and advanced therapy use (0.44% vs 0.71%-0.93%, P <0.05). Asians and Hispanics were least likely to utilize SNS therapy and most likely to use PTNS compared to Blacks and Whites. BTX use was similar between races/ethnicities (P <0.05). Female gender (OR 1.65 [CI 1.61,1.69]), younger age (<65) (OR 1.28 [1.25,1.31]), higher annual income ≥$40K (OR 1.09 [1.06,1.12]) and prior use of oral medications (OR 3.30 [3.21,3.38] for 1 medication) were significantly associated with receiving advanced therapies. Non-white race (OR 0.89 [0.87,0.91]), lower education level (less than a bachelor's degree) (OR 0.97 [0.94,0.99]), and Northeast region were associated with a lower likelihood of receiving advanced therapies (P <0.05 for all). CONCLUSION Among commercially insured, racial and socioeconomic factors predict utilization of advanced OAB therapies, including race/ethnicity, age, gender, education level, and region.
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Affiliation(s)
- Raveen Syan
- Department of Urology, University of Miami, Miami, FL.
| | | | - Ekene A Enemchukwu
- Department of Urology, University of Miami, Miami, FL; Department of Urology, Stanford University, Stanford, CA
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Linder JA, Weissman JS, Reyes Nieva H, Lipsitz S, Haring RS, DeAngelis J, Kristy RM, Loughlin KR. Overactive bladder in an integrated delivery system: a longitudinal cohort study. BMC Health Serv Res 2020; 20:447. [PMID: 32434511 PMCID: PMC7238545 DOI: 10.1186/s12913-020-05315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overactive bladder (OAB) is common and morbid. Medication and diagnosis claims may be specific, but lack sensitivity to identify patients with overactive bladder. We used an "electronic health record (EHR) phenotype" to identify cases and describe treatment choices and anticholinergic burden for OAB. METHODS We conducted a retrospective cohort study in a large, integrated health delivery system between July 2011 and June 2012 (2-year follow-up). We examined care from primary care and specialty clinics, medication and procedure use, and anticholinergic burden for each patient. RESULTS There were 7362 patients with an EHR OAB phenotype; 50% of patients were > 65 years old, 74% were female, and 83% were white. The distribution of care included primary care physician (PCP)/specialty co-management (25% of patients); PCP care only (18%); urology only (13%); or some other combination of specialty care (33%). Only 40% of patients were prescribed at least 1 OAB medication during the study. The mean duration of prescribed medication was 1.5 months (95% confidence interval [CI], 1.4 to 1.6 months; range, < 1 month to 24 months). Independent predictors of receipt of an OAB medication included increasing age (odds ratio [OR], 1.4 for every 10 years; 95% CI, 1.4 to 1.5), women (OR, 1.6 compared with men; 95% CI, 1.4 to 1.8), diabetes (OR, 1.3; 95% CI, 1.1 to 1.5), and certain sources of care compared with PCP-only care: PCP/specialty co-management (OR, 1.8; 95% CI, 1.5 to 2.0), urology (OR, 2.2; 95% CI, 1.8 to 2.6), and multiple specialists (OR, 1.4; 95% CI, 1.2 to 1.8). Very few patients received other treatments: biofeedback (< 1%), onabotulinumtoxinA (2%), or sacral nerve stimulation (1%). Patients who received OAB medications had significantly higher anticholinergic burden than patients who did not (anticholinergic total standardized daily dose, 125 versus 46; P < .001). CONCLUSIONS Although OAB is common and morbid, in a longitudinal study using an EHR OAB phenotype 40% of patients were treated with OAB medication and only briefly.
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Affiliation(s)
- Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Harry Reyes Nieva
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Sterling Haring
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Rita M Kristy
- Astellas Pharma Global Development, Northbrook, IL, USA
| | - Kevin R Loughlin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Practice Patterns for Women With Overactive Bladder Syndrome: Time Between Medications and Third-Line Treatments. Female Pelvic Med Reconstr Surg 2020; 26:431-436. [DOI: 10.1097/spv.0000000000000811] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Sanderson DJ, Gevelinger M, Jaworski E, Doyle PJ. Sleep disturbance changes in women after treatment of refractory overactive bladder with sacral neuromodulation. Investig Clin Urol 2020; 61:231-237. [PMID: 32158975 PMCID: PMC7052411 DOI: 10.4111/icu.2020.61.2.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/16/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study is to evaluate changes in sleep disturbance following treatment of overactive bladder with sacral neuromodulation. Materials and Methods This is a sub-analysis of data collected from an institutional review board approved retrospective cohort study evaluating women with Patient-Reported Outcomes Measurement Information System-Sleep Disturbance (PROMIS-SD) before and after sacral neuromodulation for overactive bladder between March 2016 and October 2017. Data collected included demographics, clinical characteristics, and additional PROMIS item banks. Within-group analysis was performed with paired t-tests. Groups based up on PROMIS-SD improvement (change <0) were then compared using Fisher's exact test, t-test, or Mann-Whitney U-test as appropriate. Results Those with improved sleep disturbance (n=7) noted a significant mean improvement of -3.99 (95% confidence interval, -6.32, -1.65; p<0.01). Both pre- and post-procedure PROMIS-Physical Function (38.86±2.35 vs. 34.13±5.58, p=0.07 and 37.14±5.10 vs. 35.44±4.74, p=0.53), Pain Interference (60.04±6.34 vs. 65.50±6.20, p=0.13 and 57.89±5.08 vs. 64.73±7.35, p=0.07), Depression (44.2±4.73 vs. 61.29±9.53, p=0.17 and 54.29±6.25 vs. 57.96±11.42, p=0.47) t-scores were similar between sleep response groups. Conclusions Those with improved sleep disturbance reported significant changes after sacral neuromodulation for overactive bladder. However, no significant differences were identified between those with and without improvement. Further investigation of changes in sleep disturbance and factors affecting change are needed within this population.
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Affiliation(s)
- Derrick J Sanderson
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Matthew Gevelinger
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Elaine Jaworski
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Paula J Doyle
- Department of Obstetrics and Gynecology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.,Department of Urology, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
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A Patient-Centered Approach to Refractory Overactive Bladder and Barriers to Third-Line Therapy. Obstet Gynecol 2020; 134:141-148. [PMID: 31188332 DOI: 10.1097/aog.0000000000003320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the decision-making process in women who do not pursue treatment with onabotulinumtoxinA, sacral neuromodulation, or percutaneous nerve stimulation in patients with overactive bladder (OAB). METHODS This was a qualitative research study. Participants were females aged 18-80 years with a diagnosis of OAB and were evaluated by a urologic or urogynecologic physician between January 2017 and March 2018. Patients who were counseled for third-line therapy, refractory to two or more medications, or lost to follow-up after initiating a second medication were considered study candidates. Data were gathered using a semi-structured phone interview. Interview topics included medical knowledge and beliefs, quality of life, and treatment experience. The interviews were transcribed and coded thematically using grounded theory. RESULTS Of a total of 381 women, 56 women qualified for our study. The average interview length was 30 minutes, and theoretical saturation occurred at 30 interviews. General themes included treatment delay, education, treatment attitudes, and office factors. The most common modifiable barrier to third-line therapy was insufficient in-office education. Participants expressed a poor understanding of the etiology, natural history, and treatment options for OAB. Participants were heavily influenced by outside factors including the opinions of friends and the media. Negative experiences with less-advanced options and treatment fatigue negatively affected participants' perceptions of third-line therapies. Office factors such as wait times and male physicians also negatively affected participants' ability to discuss their bladder symptoms. CONCLUSION In conclusion, office education is tremendously important to patients' understanding of OAB, expectations of therapy, and treatment compliance. Education about third-line therapy counseling should be incorporated into the initial office visit. This may mitigate expectations, improve patient compliance, and promote graduation to advanced therapy in women who later go on to develop refractory symptoms.
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Initial Evaluation of a Novel Modulated Radiofrequency-based Bladder Denervation Device. Urology 2019; 134:237-242. [PMID: 31539508 DOI: 10.1016/j.urology.2019.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if targeted and modulated radiofrequency ablation (RFA) of the urinary bladder using our novel ablation device (Denerblate) reduces bladder nerve density, potentially leading to a novel strategy for the management of overactive bladder. METHODS Fifteen pigs were divided into 4 groups: control (n = 3), 1-week (n = 4), 4-week (n = 4) and 12-week (n = 4) survival times. Denerblate was deployed on the trigone area of the bladder. Three 240-second cycles of modulated RFA were applied with 30 seconds between cycles. At the end of each survival term, urinary bladders were harvested for histopathologic evaluation. Nerve count and density were manually calculated. RESULTS All procedures were successfully completed, and all animals survived to the desired time points. Mean nerve density (nerves/mm2) was highest in the control and 1-week survival group compared to the 4-week and 12-week groups, both of which demonstrated significant diminishment. Nerve density in the bladder neck at control, 1 week, 4 weeks, and 12 weeks were 1.8, 1.35, 0.87, and 0.12, respectively (P <.001). Nerve density in the bladder trigone area at control, 1 week, 4 weeks, and 12 weeks were 1.5, 0.98, 0.65, and 0.112, respectively (P <.001). Epithelial heat injury was observed in 14.3% at 1 week, 10.7% at 4 weeks, but completely resolved by 12 weeks. CONCLUSION In the porcine model, modulated RFA delivered by our novel device reduced nerve density in the bladder neck and trigone by 88.6% and 88.9% at 12 weeks without evidence of lasting epithelial injury.
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Patient navigation for overactive bladder improves access to care. Int Urogynecol J 2019; 31:1007-1012. [PMID: 31463529 DOI: 10.1007/s00192-019-04085-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patients with overactive bladder (OAB) become discouraged with medication therapy because of the side effects, minimal subjective improvement and costs of therapy. With the implementation of a patient navigation pathway there is increased communication, subsequently leading to increased patient retention rates and utilization of third-line therapies. METHODS This was a quality improvement study carried out over a 17-month period comparing utilization of a navigation pathway versus patients without navigation. The data were obtained using an online database (PPS Analytics) to compare medication use, cystoscopy, urodynamic studies, use of third-line therapy, and return visits. RESULTS A total of 535 patients were included in the analysis and broken down into two respective groups. Group 1 were those placed on the navigation pathway and able to be reached via telephone (n = 431). Group 2 were those started on the navigation pathway who were not able to be reached via telephone, but were chart reviewed by a navigator (n = 104). Third-line therapy usage for groups 1 and 2 was 24% and 11% respectively. Return visits for additional OAB management for groups 1 and 2 were found to be 71% and 50% respectively. CONCLUSION Patient retention levels and utilization of third-line therapies are significantly improved when utilizing a navigation pathway. With 24% of the patients included in this study opting for third-line therapy, this represents a 600% increase in third-line therapies over national averages.
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Parkhomenko E, Yoon R, Okhunov Z, Patel RM, Dolan B, Kaler K, Schwartz MJ, Shah PH, Bierwiler H, Gamboa AJ, Miano R, Germani S, Fabbro DD, Zordani A, Micali S, Kavoussi LR, Clayman RV, Landman J. Multi-institutional Evaluation of Producing and Testing a Novel 3D-Printed Laparoscopic Trainer. Urology 2018; 124:297-301. [PMID: 30419263 DOI: 10.1016/j.urology.2018.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/06/2018] [Accepted: 06/19/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To create, distribute, and evaluate the efficacy of a portable, cost-effective 3D-printed laparoscopic trainer for surgical skills development. METHODS The UCI Trainer (UCiT) laparoscopic simulator was developed via computer-aided designs (CAD), which were used to 3D-print the UCiT. Once assembled, a tablet computer with a rear-facing camera was attached for video and optics. Four institutions were sent the UCiT CAD files with a 3D-printer and instructions for UCiT assembly. For a comparison of the UCiT to a standard trainer, peg transfer and intracorporeal knot tying skills were accessed. These tasks were scored, and participants were asked to rate their experience with the trainers. Lastly, a questionnaire was given to individuals who 3D-printed and assembled the UCiT. RESULTS We recruited 25 urologists; none had any 3D-printing experience. The cost of printing each trainer was $26.50 USD. Each institution used the Apple iPad for optics. Six of eight participants assembled the UCiT in < 45 minutes, and rated assembly as somewhat easy. On objective scoring, participants performed tasks equally well on the UCiT vs the conventional trainer. On subjective scoring, the conventional trainer provided a significantly better experience vs the UCiT; however, all reported that the UCiT was useful for surgical education. CONCLUSION The UCiT is a low cost, portable training tool that is easy to assemble and use. UCiT provided a platform whereby participants performed laparoscopic tasks equal to performing the same tasks on the more expensive, nonportable standard trainer.
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Affiliation(s)
| | - Renai Yoon
- Department of Urology, University of California, Orange, CA
| | | | - Roshan M Patel
- Department of Urology, University of California, Orange, CA
| | - Benjamin Dolan
- Department of Engineering, University of California, Irvine, CA
| | - Kamaljot Kaler
- Department of Urology, University of California, Orange, CA
| | - Michael J Schwartz
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | - Paras H Shah
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | - Hannah Bierwiler
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | - Aldrin Joseph Gamboa
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Roberto Miano
- Department of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Germani
- Department of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Dario Del Fabbro
- Department of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Zordani
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Louis R Kavoussi
- Department of Urology, Smith Institute for Urology, North Shore LIJ, New Hyde Park, NY
| | | | - Jaime Landman
- Department of Urology, University of California, Orange, CA.
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Sinha S, Yande S, Patel A, Vaze A, Sarkar K, Raina S, Agarwal MM, Vasudeva P, Khattar N, Madduri VKS, Mishra N, Jain A, Gupta M. The Urological Society of India survey on urinary incontinence practice patterns among urologists. Indian J Urol 2018; 34:202-210. [PMID: 30034131 PMCID: PMC6034410 DOI: 10.4103/iju.iju_85_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Shirish Yande
- Department of Urology, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anita Patel
- Department of Urology, Global Hospital and KEM Hospital, Mumbai, Maharashtra, India
| | - Ajit Vaze
- Department of Urology, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Kalyan Sarkar
- Department of Urology, Vivekananda Institute, Kolkata, West Bengal, India
| | - Shailesh Raina
- Department of Urology, Jaslok Hospital, Mumbai, Maharashtra, India
| | - Mayank Mohan Agarwal
- Department of Urology, Aster Dr Ramesh Multispecialty Hospitals, Guntur, Andhra Pradesh, India
| | - Pawan Vasudeva
- Department of Urology, VM Medical College and Safdarjung Hospital, New Delhi, India
| | - Nikhil Khattar
- Department of Reconstructive and Female Urology, Medanta Hospital, Gurgaon, Haryana, India
| | - Vijay Kumar Sarma Madduri
- Department of Renal Transplant and Urology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Amita Jain
- Department of Urogynecology, Fortis Escorts Hospital, New Delhi, India
| | - Manu Gupta
- Department of Urology, Sir Ganga Ram Hospital, New Delhi, India
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