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Urologists' referral attitude for sacral neuromodulation for treating refractory idiopathic overactive bladder syndrome: Discrete choice experiment


Kessler, Thomas M; Maric, Angelina; Mordasini, Livio; Wöllner, Jens; Pannek, Jürgen; Mehnert, Ulrich; van Kerrebroeck, Philip E; Bachmann, Lucas M (2014). Urologists' referral attitude for sacral neuromodulation for treating refractory idiopathic overactive bladder syndrome: Discrete choice experiment. Neurourology and Urodynamics, 33(8):1240-1246.

Abstract

AIMS: To investigate urologists' referral attitude for sacral neuromodulation (SNM) for treating refractory idiopathic overactive bladder syndrome (OAB) and to quantify the weight they attribute to clinical parameters to refrain from SNM referral. METHODS: We set up a vignette study using a discrete-choice design. The questionnaires were distributed at two national urological meetings. RESULTS: One hundred eight urologists completed the questionnaire. Three parameters were significantly associated with the decision to refrain from referral: absolute contraindications for SNM (anatomical low bladder compliance, current urinary tract infection, progressive neurological disease, urinary tumors) had the strongest association (0.78, 95% CI 0.58 to 0.97; P < 0.001), followed by cardiac pacemaker (0.24, 95% CI 0.08 to 0.39; P = 0.003), and diabetes mellitus (0.19, 95% CI 0.06 to 0.32; P = 0.006). On the other hand, urologists considered fecal incontinence as an important parameter for referral (-0.16, 95% CI -0.29 to -0.04; P = 0.011). Current medication with antimuscarinics and polyuria played no role in the decision. Results in a subgroup of 24 neuro-urologists/functional urologists were similar but non-critical parameters were not associated with the decision to refrain from SNM referral. CONCLUSIONS: Besides absolute contraindications, other non-critical parameters such as cardiac pacemaker or diabetes mellitus influence urologists' decision to refrain from referral for SNM. We believe that the use of decision tools will help urologists identifying patients benefiting from SNM and therefore we call for broad dissemination of such tools into clinical practice. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.

Abstract

AIMS: To investigate urologists' referral attitude for sacral neuromodulation (SNM) for treating refractory idiopathic overactive bladder syndrome (OAB) and to quantify the weight they attribute to clinical parameters to refrain from SNM referral. METHODS: We set up a vignette study using a discrete-choice design. The questionnaires were distributed at two national urological meetings. RESULTS: One hundred eight urologists completed the questionnaire. Three parameters were significantly associated with the decision to refrain from referral: absolute contraindications for SNM (anatomical low bladder compliance, current urinary tract infection, progressive neurological disease, urinary tumors) had the strongest association (0.78, 95% CI 0.58 to 0.97; P < 0.001), followed by cardiac pacemaker (0.24, 95% CI 0.08 to 0.39; P = 0.003), and diabetes mellitus (0.19, 95% CI 0.06 to 0.32; P = 0.006). On the other hand, urologists considered fecal incontinence as an important parameter for referral (-0.16, 95% CI -0.29 to -0.04; P = 0.011). Current medication with antimuscarinics and polyuria played no role in the decision. Results in a subgroup of 24 neuro-urologists/functional urologists were similar but non-critical parameters were not associated with the decision to refrain from SNM referral. CONCLUSIONS: Besides absolute contraindications, other non-critical parameters such as cardiac pacemaker or diabetes mellitus influence urologists' decision to refrain from referral for SNM. We believe that the use of decision tools will help urologists identifying patients benefiting from SNM and therefore we call for broad dissemination of such tools into clinical practice. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2014
Deposited On:13 Dec 2013 11:46
Last Modified:05 Apr 2016 17:15
Publisher:Wiley-Blackwell
ISSN:0733-2467
Publisher DOI:https://doi.org/10.1002/nau.22490
PubMed ID:24127359

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