Turk J Urol 2017 Mar 27;43(1):68-74. Epub 2017 Jan 27.
Department of Urology, Marmara University School of Medicine, İstanbul, Turkey.
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.