Faculty Bibliography

OBJECTIVE: To explain what role urinary urgency has on urinary frequency in patients with overactive bladder (OAB). MATERIALS AND METHODS: We prospectively enrolled 102 patients with OAB over a 6-week period. Patients were assessed with the OAB-q and a pilot questionnaire to identify which urinary symptoms were most bothersome and what underlying cause subjects attributed urinary frequency to. Associations between epidemiologic characteristics, OAB-q scores, and subject responses to the pilot questionnaire, were examined for statistical significance with the Pearson chi square test. RESULTS: The study population comprised 85% women and 15% men, with mean age 67.4 years and mean OAB-q score 54. Subjects reported their most bothersome symptom was: frequency 24.5%, urgency or urgency incontinence 48.0%, nocturia 27.5%. Of the patients most bothered by frequency, 64% identified the International Continence Society definition of urgency or "fear of leakage" as the underlying reason for their frequency. Overall, 82.4% and 48.0% of patients reported urgency or urgency incontinence as a symptom and most bothersome symptom respectively. However, when patients were specifically asked what drives their urinary frequency, these percentages increased to 89.2% and 63.7%. CONCLUSION: This pilot study confirms that urgency is a large factor underlying the drive to void frequently in OAB, even when patients do not admit to urgency as the most bothersome symptom.

PURPOSE: Many investigators have used number of pads to determine severity of post prostatectomy incontinence (PPI), yet the accuracy of this tool remains unproven. The aim of this study was to determine if patient's perception of pad use and urine loss reflects actual urine loss. We also sought to identify a quality of life (QoL) measure that distinguishes patients by severity of incontinence. MATERIALS AND METHODS: We prospectively enrolled 235 men from 18 sites >6 months after radical prostatectomy, with incontinence requiring protection. Patients completed a questionnaire about perception of number, size and wetness of pads and a QoL question, several standardized incontinence questionnaires, and a 24-hour pad test that assessed number, size, and weight of pads. SPSS was used for statistical analysis. RESULTS: Perception of number of pads used was in close agreement with number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p<0.001). Patients with "wet" and "soaked" pads had statistically, and clinically, significantly different pad weights uniquely different from each other, and from the "almost dry" and "slightly wet". The response to the QoL question separated men in to 4 statistically significantly different groups based on mean 24-hour pad weight. CONCLUSIONS: Patients accurately describe the number, size and the degree of wetness of pads collected during a 24-hour pad test. These correlate well with actual urine loss. The single question of "To what extent does urine loss affect your quality of life?" separated men into distinct categories.

Objective: To identify barriers multiple sclerosis (MS) patients experience in seeking evaluation for urinary symptoms and its relationship to the Actionable Bladder Symptom and Screening Tool (ABSST). Background: The ABSST is used to identify urinary symptoms in patients with MS and may identify patients in need of referral and evaluation for neurogenic overactive bladder symptoms (NDO). Although up to 80% of MS patients may experience urinary symptoms, evaluation by a specialist and treatment are under-utilized in this population. Methods: This was a prospective observational study. 100 patients with MS, but currently not seeing a genitourinary specialist were enrolled from an MS comprehensive center with a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) physician on staff. Patients completed demographic information, a short form of the ABSST and questions to assess barriers to seeking a specialist for bladder problems. An ABSST score >3 met criteria for referral and evaluation. In addition they were asked a single item question about their desire to be evaluated by a specialist for bladder problems. Two-month after enrollment, follow up calls assessed whether patients had seen a specialist to assess their urinary complaints. X² tests were used to compare categorical variables. Results: Of the 100 patients, there were 79 women and 21 men, mean age was 44.5 years and average time since diagnosis of MS was 10.4 years. Ethnicities included 45% Caucasian, 21% African American, 21% Hispanic, 2% Asian, and 11% Other/Multiracial. Overall, 40% of patients indicated that they would want to see a specialist to evaluate their bladder symptoms and 33% of patients had already seen one in the past. Most frequent reasons for seeking prior care were incontinence (46%) and recurrent UTIs (24%). Overall, the most common barriers to seeking care included "Doctor never referred" (18%), "Doctor never asked" (15%), "Had enough problems to deal with" (15%), "Thought there were no treatments available" (12.5%) and "Felt embarrassed" (10%). 40% of men stated "Doctor had never referred or asked" compared to 10% of women (p=0.002). 27 patients had an ABSST Score>3 and were more interested in seeing a specialist compared to those scoring <3 (91% vs. 40%; p= .000). When compared to patients with an ABSST<3, those with an ABSST>3 had a significant difference in level of education (p<0.05), type of mobility used (p<0.05), and employment status (p=0.005). Patients with an ABSST >3 cited limitations associated with insurance, cost, transportation, or inaccessibility more often than those with an ABSST <3 (9% vs. 3%, p=0.009). After 2 months, 49 patients were reached for follow up. Despite persistent or worsening urinary symptoms in some patients, only 1 participant had followed up. Conclusions: The ABSST is a valuable tool to identify MS patients with urinary symptoms and willingness to seek evaluation. Identification of this need alone unfortunately did not result in a significant increase in evaluation, despite ongoing symptoms. This underscores that other barriers, beyond awareness such as communication, costs and logistics, play a tremendous role preventing patients getting the evaluation that is needed. Further work is required to elucidate these factors

Objective: s To characterize a sample of patients with multiple sclerosis (MS) that would be recommended for evaluation by an expert in bladder dysfunction based on the Actionable Bladder Symptom and Screening Tool (ABSST), and to correlate the ABSST with several commonly used questionnaires including the Overactive Bladder Questionnaire (OABq), Patient Global Impression of Severity (PGI-S), International Consultation on Incontinence Questionnaire (ICIQ), and Medical Epidemiology and Social Aspects of Aging (MESA). Background: Although up to 80% of patients diagnosed with multiple sclerosis (MS) experience lower urinary tract symptoms, evaluation and treatments are significantly under accessed. The (ABSST) is a newly validated tool that can be used in patients with MS to screen for neurogenic overactive bladder symptoms (NDO). It is a simple 8-item questionnaire that aids in identifying patients that need a referral for evaluation. Methods: This was a prospective observational study. 100 patients diagnosed with MS, not currently seeing a bladder dysfunction specialist, were enrolled from an MS center. After obtaining consent, patients were asked to fill out a validated short form of the ABSST, the OABq short form, the PGI-S, the ICIQ and the MESA. An ABSST score >3 is considered a positive screening test and met criteria for referral to a specialist. OAB subscale scores grouped responses related to symptom bother and Quality of life (HRQL), which was further subdivided into HRQL-Coping, HRQL-Sleep, or HRQL-Emotions. A high score for the symptoms subscale indicated worse symptoms and a low score of the quality of life subscales indicated worse quality of life. The MESA scores grouped responses that characterized either urgency or stress incontinence. There were no subscales for PGIS or ICIQ. Mean questionnaire scores were compared between patients who screened positive or negative for the ABSST using one-way ANOVA and X2 tests. Results: Patient's mean age was 44.5 years and average time since diagnosis was 10.4 years. There were 79 women and 21 men. Ethnicities included 45% Caucasian, 21% African American, 21% Hispanic, 2% Asian, and 11% Other/Multiracial. 27 patients had an ABSST Score >3. When compared to patients with an ABSST<3, those with an ABSST>3 had a significant difference in level of education (p<0.05), level of mobility (p<0.05), and employment status (p=0.005). See figure 1. Patients with an ABSST>3 were more likely to have seen a doctor in the past for bladder problems (52% vs. 27%; p=0.019), more frequently for urinary incontinence (19%) and urinary tract infections (13%). They were also more likely to be using medications for bladder symptoms (23% vs. 4%; p=0.004) or to have used them in the past (42% vs. 15%; p=0.004). Patients with a positive ABSST had a significant difference in the mean scores of the following subscales: OABq Symptoms (57.4 vs. 15.0; p=0.000); OAB-Total HRQL (50.4 vs. 89.9;p=0.000); OABHRQL Cope (43.4 vs. 89.4;p=0.000); OAB-HRQL Sleep (42.5 vs. 84.2; p=0.000); OAB-HRQL Emotion (62.1 vs. 93.7; p=0.000); MESA-Urgency Incontinence (40.4 vs. 12.3; p=0.000); MESA-Stress Incontinence (33.8 vs.15.0; p=0.000); and ICIQ-SF (8.2 vs. 2.3; p=0.000). There was a significant correlation between PGIS Score and a positive ABSST (p=0.000). Conclusions: The differences observed in MS patients who score positive on the ABSST may represent the progressive nature of some cases of MS and its association with NDO. A positive screening response correlates and captures the severity of symptoms, impact on quality of life and classifications of both urinary incontinence across several overactive bladder and urinary incontinence questionnaires. These findings highlight the importance of continued screening in MS patients for NDO, even when patients have been evaluated or treated in the past. This need makes the ABSST a valuable simple tool for providers to efficiently identify and refer MS patients for further evaluation and treatment. (Figure presented)

Introduction: Social media networks and websites are an important source of healthcare information exchange. Despite the quantity of information, there is growing evidence for poor quality medical information that may be misleading and biased. Some studies suggest information available online on controversial topics may disperse inaccurate information and contribute to public confusion. Objective: The goal of this study is to examine information available in YouTube videos on a controversial urologic topic, pelvic organ prolapse (POP) repairs with mesh. Methods: A keyword search of ''vaginal POP repair with mesh'' was performed and the first 100 search results examined on 7/29/13. Videos not in English, lacking spoken words, or duration 910 minutes were excluded. Video characteristics including source (legal, medical, other), number of views, time online and duration were recorded. The content of each video was assessed in the following domains: description of POP, management of POP, explanation of the 2011 FDA Safety Communication, and balanced presentation of information. Scores were assigned based on whether the video made a series of objective statements pertaining to each domain, The proportion of statements made in the video per domain was calculated and videos of different sources were compared. Significance was assessed by t test. Results: 51 videos were excluded, and the remaining 49 were viewed. The sources were 69% legal firm, 24% medical institution, and 7% other. The former 2 groups were compared. Videos from medical institutions were older (online for 31.6 vs. 14.2 months, p lt; 0.01), longer (249 vs 99 seconds, p lt; 0.01), and had more views per month (784 vs. 140 , p lt; 0.01) when compared to legal videos. Legal videos explained more aspects of the 2011 FDA Safety Communication (0.22 vs. 0.07; p<0.01). Medical videos did not show a significant difference in addressing aspects of other domains including description of POP (0.25 vs. 0.12, p=0.087, management of POP (0.2 vs. 0.14, p=0.086), or presentation of balanced information (0.10 vs. 0.06; p=.528). Conclusions: The majority of information available in YouTube videos on the topic of vaginal POP repair with mesh is recent, short, and published through legal services that outline the 2011 FDA Safety communication but contain less comprehensive descriptions of POP compared to other videos. However, low overall scores in all domains studied, regardless of source, demonstrate lack of content. This raises questions about the utility of YouTube as a source of information for patients