TY - JOUR
T1 - Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study
AU - the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort Study Group
AU - Bretschneider, Carol Emi
AU - Liu, Qian
AU - Smith, Abigail R.
AU - Kirkali, Ziya
AU - Amundsen, Cindy L.
AU - Lai, Henry
AU - Geynisman-Tan, Juila
AU - Kirby, Anna
AU - Cameron, Anne P.
AU - Helmuth, Margaret E.
AU - Griffith, James W.
AU - Jelovsek, John Eric
N1 - Funding Information:
This is publication number 31 of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). This study is supported by the National Institute of Diabetes & Digestive & Kidney Diseases through cooperative agreements (grants DK097780, DK097772, DK097779, DK099932, DK100011, DK100017, DK099879). Research reported in this publication was supported at Northwestern University, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The following individuals were instrumental in the planning and conduct of this study at each of the participating institutions: Duke University, Durham, North Carolina (DK097780): PIs: Cindy Amundsen, MD, John Eric Jelovsek, MD, MMEd, MSDS; Co-Is: Kathryn Flynn, PhD, Jim Hokanson, PhD, Aaron Lentz, MD, David Page, PhD, Nazema Siddiqui, MD, Kevin Weinfurt, PhD, Lisa Wruck, PhD, Michelle O'Shea, MD, PhD, Todd Harshbarger, PhD; Study Coordinators: Paige Green, Magaly Guerrero. University of Iowa, Iowa City, IA (DK097772): PIs: Catherine S. Bradley, MD, MSCE, Karl Kreder, MD, MBA; Co-Is: Bradley A. Erickson, MD, MS, Daniel Fick, MD, Vince Magnotta, PhD, Philip Polgreen, MD, MPH; Study Coordinators: Sarah Heady, Chelsea Poesch, Shelly Melton, Jean Walshire. Northwestern University, Chicago, IL (DK097779): PIs: James W. Griffith, PhD, Kimberly Kenton, MD, MS, Brian Helfand, MD, PhD; Co-Is: Carol Bretschneider, MD, David Cella, PhD, Sarah Collins, MD, Julia Geynisman-Tan, MD, Alex Glaser, MD, Christina Lewicky-Gaupp, MD, Margaret Mueller, MD, Devin Boehm, BS; Study Coordinators: Sylwia Clarke, Melissa Marquez, Malgorzata Antoniak, Pooja Talaty, Francesca Moroni, Sophia Kallas. Dr. Helfand and Ms. Talaty are at NorthShore University HealthSystem. University of Michigan Health System, Ann Arbor, MI (DK099932): PI: J. Quentin Clemens, MD, FACS, MSCI; Co-Is: John DeLancey, MD, Dee Fenner, MD, Rick Harris, MD, Steve Harte, PhD, Anne P. Cameron, MD, Aruna Sarma, PhD, Giulia Lane, MD; Study Coordinators: Linda Drnek, Greg Mowatt, Sarah Richardson, Julia Chilimigras, Diana O'Dell. University of Washington, Seattle Washington (DK100011): PI: Claire Yang, MD; Co-I: Anna Kirby, MD; Study Coordinators: Brenda Vicars, RN, Lauren Daniels. Washington University in St. Louis, St. Louis Missouri (DK100017): PI: H. Henry Lai, MD; Co-Is: Gerald L. Andriole, MD, Joshua Shimony, MD, PhD, Fuhai Li, PhD; Study Coordinators: Linda Black, Vivien Gardner, Patricia Hayden, Diana Wolff, Aleksandra Klim, RN, MHS, CCRC. Arbor Research Collaborative for Health, Data Coordinating Center (DK099879): PI: Robert Merion, MD, FACS; Co-Is: Victor Andreev, PhD, DSc, Brenda Gillespie, PhD, Abigail Smith, PhD; Project Manager: Melissa Fava, MPA, PMP; Clinical Monitor: Melissa Sexton, BA, CCRP; Research Analysts: Margaret Helmuth, MA, Jon Wiseman, MS, Jane Liu, MPH, Sarah Mansfield, MS. National Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney, Urology, and Hematology, Bethesda, MD: Project Scientist: Ziya Kirkali MD; Project Officer: Christopher Mullins PhD; Project Advisor: Julie Barthold, MD. Shauna Leighton, Medical Editor with Arbor Research Collaborative for Health, provided editorial assistance on this manuscript.
Funding Information:
This study is supported by the National Institute of Diabetes & Digestive & Kidney Diseases through cooperative agreements (grants DK097780, DK097772, DK097779, DK099932, DK100011, DK100017, DK099879).
Funding Information:
Research reported in this publication was supported at Northwestern University, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2023/1
Y1 - 2023/1
N2 - Background: Limited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation. Objectives: To describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year. Study Design: The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up. Results: Among 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score. Conclusions: Treatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated.
AB - Background: Limited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation. Objectives: To describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year. Study Design: The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up. Results: Among 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score. Conclusions: Treatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated.
KW - discontinuation
KW - therapy
KW - treatment outcome
KW - urge incontinence
KW - urgency
UR - http://www.scopus.com/inward/record.url?scp=85140248259&partnerID=8YFLogxK
U2 - 10.1002/nau.25067
DO - 10.1002/nau.25067
M3 - Article
C2 - 36579974
AN - SCOPUS:85140248259
SN - 0733-2467
VL - 42
SP - 194
EP - 204
JO - Neurourology and Urodynamics
JF - Neurourology and Urodynamics
IS - 1
ER -