Turkish Continence Society aims to analyze how overactive bladder (OAB) is being managed in daily practice by the urologists in Turkey. The initial management approaches and treatment strategies during the follow-up were investigated in this study.

This multicentric study of the Turkish Continence Society was designed to represent the whole population so that randomly-selected 14 urology departments were included. The country was divided into 9 regions. Random hospitals were selected from these regions. At least one university hospital and one state hospital were selected in each region randomly. A total of 500 patients were planned to be recruited after power analysis. An online data entry and storage software was created. After the ethics committee approval and the assignment of the usernames and passwords for each investigator, patient recruitment was initiated as of January 2017. The study included the demographic variables, initial data and first-year follow-up data of each patient. 
Adult patients (>18 years old) with the diagnosis of OAB were included. Exclusion criteria were; history of lower urinary tract surgery, medical or surgical treatment due to BPH, diagnosis of prostate and/or bladder cancer, urinary tract infection, bladder stones, neurogenic bladder, bladder pain syndrome and renal failure.   
A survey including demographic data, daily habits, lower urinary tract symptoms and Turkish-validated OAB and ICIQ-SF questionnaires were given to all patients. Second part of the survey, including the questions about clinical evaluation and management of the patient, was completed by the treating physician. Then, all the parameters were transferred to the online database.

The data of 507 patients (394 female and 113 male) from 14 centers were included in this preliminary report. Mean age was 51.7 in female and 45.3 in male patients. Mean OAB scores were 26.137.52 in female and 24.457.49 in male patients (p=0.036). The rate of wet OAB was significantly higher in female (87.6%) than in male patients (57.5%) (p=0.001). The degree by which quality of everyday life was affected according to ICIQ-SF questionnaire was significantly higher in female patients (p=0.001). Bladder diary was requested for 59.5% and 52.7% of the female and male patients, respectively.
Behavioral therapy was recommended to 81.4% and 73.2% of the female and male patients, respectively (p=0.063). In the first visit, 86.1% of the female and 89.3% of the male patients were given antimuscarinics, respectively (p=0.431). Medical treatment was continued in 78.9% of the male and 74.2% of the female patients (p=0.403). Primary reasons for treatment modification were low patient satisfaction rate or treatment inefficacy which were reported by 18.8% of the female and 20.6% of the male patients (p=0.726). Antimuscarinic-related side effects occurred in 94.9% and 88.9% of the female and male patients, respectively (p=0.085). However, the rate of medical treatment change due to antimuscarinic-related side effects was only 1.7% in female and 4.8% in male patients.

In the second visit, mean OAB scores decreased to 10.08.25 in female and 12.037.46 in male patients (p=0.006). Patient satisfaction rates were assessed as; 5.2% and 6.5% not satisfied, 5.2% and 3.2% not satisfied at all, 17.6% and 19.4% a little satisfied, 40.1% and 46.8% quite satisfied, 31.8% and 24.2% very satisfied for female and male patients, respectively (p=0.706).

The majority of the studies focusing on the management of OAB report the outcomes of various treatment modalities. The guidelines are mainly based on the outcomes of the clinical trials with higher level of evidence. The management of OAB in daily practice among urologists, as initial treatment approach or the strategies in refractory patients have not been investigated before. Bladder diaries are useful tools to understand the symptoms of the patient objectively and are considered as a basic method for performing urodynamics. However, explaining the diary and having it filled preferably for 3 consecutive days may sometimes be challenging in routine daily practice. We have found out that in more than half of the patients, bladder diaries were used for diagnosis. Although behavioral therapy was frequently utilized, antimuscarinics were recommended in most of these patients which means behavioral treatment was rarely used alone.
Poor efficacy, switch to a new medication, learning to adapt without medication, and side effects are some of the most common reasons for discontinuation of antimuscarinics in patients with OAB (1). In our study, the main reason for medical treatment change was low patient satisfaction and low efficacy during the follow-up. Although side effects were observed in almost all patients, it was not a reason for treatment discontinuation in most instances. Overall, our results demonstrated high patient satisfaction in the management of OAB.

This is the first study investigating the management of OAB in daily practice by urologists. We have shown that behavioral therapy and antimuscarinics were the commonly preferred initial treatment modalities of OAB. Although antimuscarinic-related side effects were highly prevalent, this did not lead to high rates of treatment discontinuation. In the literature; controversy exists between the results of the clinical trials and observational studies about OAB. We believe that our study and similar future trials would be helpful to understand the daily practice routines regarding the management of OAB.

Apostolidis A, Averbeck MA, Sahai A, Rahnama'i MS, Anding R, Robinson D, Gravas S, Dmochowski R. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn. 2017 Apr;36(4):882-893.