Physicians' Attitudes Towards the Treatment of Overactive Bladder in Women in the Lebanese Population
IUGA Academy. Jaffal M. Jun 30, 2018; 212801; 497 Topic: Overactive Bladder
Mohammad Jaffal
Mohammad Jaffal

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Physicians’ attitudes towards the treatment of overactive bladder in women in the Lebanese population

Itani, A1;Jaffal, M2; Bazi , T2

1: American University of Beirut Medical Center and Columbia University Mailman School of Public Health; 2: American University of Beirut Medical Center

Introduction:The management of Overactive bladder (OAB) includes non-pharmacological treatment, pharmacological treatment,and surgical intervention in refractory cases. Current guidelines support the initial use ofa variety of non-pharmacological approachessuch as behavioral modification, scheduled voiding,kegel exercise, weight reduction in overweight women, and urge suppression. These options are not only effective, but have the advantage of being cost-free and without side effects.
Objective: To evaluate the approach of urologists and gynecologists in Lebanon in the initial management of OAB in women.
Methods: Printed surveys addressing the initial management of OAB were distributed and recollected anonymously during national urology and gynecology conferences in Beirut, Lebanon. Data analysis was performed using descriptive statistics;Chi squared test and Fischer’s exact test were used to compare categorical variables.
Results: 130 completed surveys (91 gynecologists and 39 urologists) were analyzed.
19.2% of respondentswere younger than 35 years, 32.3% were 35-50 y.o, 33.1% were 51-60 y.o,, and 15.4% were older than 60. 60.8% were practicing at University affiliated hospitals. 46.9% reported that they evaluate 10-40 OAB patients per year, while 25.4% evaluate <10 patients and 27.7% evaluate > 40 OAB patients per year. Exclusive non-pharmacological treatment regimens for OAB are started by 25.4% of respondents; a combination of pharmacological and non-pharmacologicaltreatment is used by 43.8%, while 30.8% prescribe exclusive pharmacological treatment at the initial visit. Specialty significantly correlated to initial treatment modality (p=0.043). Compared to gynecologists, urologists were 1.91 times more likely to start exclusive pharmacological treatment, (CI 1.16-3.14). The choice of treatment modality was not correlated to the number of years in practice (p=0.223) or university affiliation (p=0.433). While the number of OAB patients evaluated per year did not significantly correlate to the three treatment modalities (p= 0.224), practitioners evaluating <10 OAB patients per year were 2.6 times more likely to start exclusive non-pharmacological treatment compared to those who evaluate > 40 patients per year (CI 1.03-6.64). Amongnon-pharmacological treatment options, behavioral therapy was the most frequently used (94.4%), followed by weight reduction (82.2%), and scheduled voiding (71.1%), and Kegel exercises (67.8%), and urge suppression (31.1%). Practitioners who start exclusive non-pharmacologicaltreatment justified their decision on the basis of medication cost (75.7%), or medication side effects (24.3%). Only 30% of all respondents believe that OAB medications are effective long term (>6 months), and 40% believe that only a minority of patients will be using these medications after 6 months. Practitioners who only prescribe medications at the initial visit cited the lack of effectiveness as the most common reason for excluding non-pharmacological treatment options. Within this group, there was a statistically significant difference between the two extremes of age brackets (<35 y.o vs >60 y.o) where older physicians were more likely to believe that most non-pharmacological options are not effective, compared to their younger colleagues (Behavioral therapy, p=002; Kegel exercises, p=0.001; scheduled voiding, p=0.011; weight reduction, p=0.006). There was no statistically significant difference between university affiliated and non-university affiliated practitioners in their attitude towards 'lack of effectiveness' of all five non-pharmacological treatment options. 68.5% of respondents acknowledge there is a gap in their specialty training regarding at least one aspect of OAB (diagnosis, pharmacological treatment, non-pharmacological treatment) with no difference between gynecologists and urologists (p=0.48). However, when non-pharmacologicaltreatment is specified, only 1 in 39 urologists and 10 in 91 gynecologists admit the presence of such gap. When analyzing the answers of those who believe there is no gap in any aspect of their OABtraining, 26.9%, 29.3%, and 31.0% stated that there is no effectiveness of behavioral treatment, weight reduction, and scheduled voiding respectively.
Conclusions: factors affecting the initial management of OAB in Lebanon include physician specialty and physician's age. A lower 'OAB patient load' correlated with higher use of non-pharmacological treatment. About two-thirds of respondents admit the presence of some gap in their training in regard to OAB. Up to 31% of those who are totally satisfied with their OAB training did not believe in the value of well-established non-pharmacological treatment options of OAB.


Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (American University of Beirut Medical Center ).

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