The Urological Society of India survey on urinary incontinence practice patterns among urologists
Sanjay Sinha1, Shirish Yande2, Anita Patel3, Ajit Vaze4, Kalyan Sarkar5, Shailesh Raina6, Mayank Mohan Agarwal7, Pawan Vasudeva8, Nikhil Khattar9, Vijay Kumar Sarma Madduri10, Nagendranath Mishra11, Amita Jain12, Manu Gupta13
1 Department of Urology, Apollo Hospitals, Hyderabad, Telangana, India
2 Department of Urology, Ruby Hall Clinic, Pune, Maharashtra, India
3 Department of Urology, Global Hospital and KEM Hospital, Mumbai, Maharashtra, India
4 Department of Urology, Lilavati Hospital, Mumbai, Maharashtra, India
5 Department of Urology, Vivekananda Institute, Kolkata, West Bengal, India
6 Department of Urology, Jaslok Hospital, Mumbai, Maharashtra, India
7 Department of Urology, Aster Dr Ramesh Multispecialty Hospitals, Guntur, Andhra Pradesh, India
8 Department of Urology, VM Medical College and Safdarjung Hospital, New Delhi, India
9 Department of Reconstructive and Female Urology, Medanta Hospital, Gurgaon, Haryana, India
10 Department of Renal Transplant and Urology, Institute of Liver and Biliary Sciences, New Delhi, India
11 Department of Urology, Jivraj Mehta Hospital, Ahmedabad, Gujarat, India
12 Department of Urogynecology, Fortis Escorts Hospital, New Delhi, India
13 Department of Urology, Sir Ganga Ram Hospital, New Delhi, India
Department of Urology, Apollo Hospitals, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
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.