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

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.

Practitioner’s knowledge, attitudes, beliefs and practices towards urinary incontinence

“…Most HCPs indicated pelvic floor muscle training and bladder training education as an initial UI treatment option. However, few HCPs referred to specialist UI physiotherapists, which was also seen in other studies in South Africa (Padayachey 2009 ) and internationally (Anger et al 2016 ; Mandl, Halfens & Lohrmann 2015 ; Sinha et al 2018 ; Wong et al 2019 ). Unnecessary UI referral to a specialist would increase the economic burden, and few nursing HCPs knew that all UI patients did not need to be referred to a specialist.…”

“…Unnecessary UI referral to a specialist would increase the economic burden, and few nursing HCPs knew that all UI patients did not need to be referred to a specialist. Various studies (Dessie et al 2015 ; Jang et al 2015 ; Jonasson & Josefsson 2016 ; Mazloomdoost et al 2017 , 2018 ; Moskowitz et al 2018 ; Sinha et al 2018 ; Wong et al 2019 ) also noted inadequate UI referrals from HCPs. It is therefore important to address knowledge gaps regarding UI risk factors, bladder diaries and inadequate referrals and ensure that it becomes part of routine practice.…”

“…Studies from our scoping review highlighted that the knowledge, attitudes, beliefs and practices differed between HCPs, settings and countries. While we did identify a number of studies that were conducted in low-resource settings such as in Thailand (Sarit-Apirak, Udomsubpayakul & Manonai 2016 ), India (Sinha et al 2018 ) and Brazil (Tomasi et al 2017 ), we found only one study reporting conditions in South Africa. The study explored South African general practitioners’ (GPs’) knowledge, attitudes and practices regarding female patients with UI (Padayachey 2009 ).…”

What's inside?

“…The committee to frame guidelines on urinary incontinence management conducted a survey among members to assess their practice patterns to help frame these guidelines. [ 6 ]…”