Urologists' referral attitude for sacral neuromodulation for treating refractory idiopathic overactive bladder syndrome: Discrete choice experiment
Kessler TM, Maric A, Mordasini L, Wöllner J, Pannek J, Mehnert U, van Kerrebroeck PE, Bachmann LM. Neurourol Urodyn. 2013 Oct 11. doi: 10.1002/nau.22490. [Epub ahead of print]

Source

Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.

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.