Eleonora Salvini

Effects of Onabotulinum Toxin A Intradetrusor Injections on Urinary Symptoms and Sexual Life in Women Affected by Multiple Sclerosis: A Prospective Controlled Study

Background: Voiding and sexual dysfunction in Multiple Sclerosis represent the most devastating dimensions of the disease. Pharmacological treatment of voiding dysfunction could improve sexual life in patients affected by the disease. We investigated the effects of Onabotulinum toxin A intradetrusor injections on urinary symptoms and sexual dysfunction, and on the psychological status of women affected by Multiple Sclerosis with refractory overactive bladder. Methods: 41 patients underwent neurologic and urologic clinical evaluations and were administered the Female Sexual Function Index, the Incontinence-Quality of Life questionnaire, the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale, before and six months after Onabotulinum toxin A intradetrusor injection; 21 continent females affected by the disease acted as controls. Results: At baseline, all patients were incontinent and 35/41 was sexually active, with low Female Sexual Function Index scores. Mild depression and anxiety were detected in all cases with a reduced quality of life. Six months after treatment, overactive bladder symptoms improved significantly in all patients. Arousal, lubrication, orgasm-related problems and desire alterations markedly improved, together with an improvement in anxiety, depression and quality of life. Scores of Female Sexual Function Index, Incontinence-Quality of Life questionnaire, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale remained unchanged in controls. Conclusion: Onabotulinum toxin A intradetrusor injections not only control overactive bladder symptoms in women affected by multiple sclerosis, but also significantly improve sexual life.

MP75-07 SONOGRAPHY TAPE CHARACTERISTIC AND INCONTINENCE OUTCOME AFTER TRANS-OBTURATOR TAPE (TOT) SURGERY

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) (InterStim , Medtronic, Inc., Minneapolis, MN) has been used as a second-line therapy for both urinary and bowel control. There is limited data in the literature regarding trends of utilization of SNS to explore precisely who is treated with SNS. We sought to explore disparities in the utilization of SNS among Medicare beneficiaries. METHODS: A 5% national random sample of all Medicare claims for 2001, 2004, 2007, and 2010 was queried to identify patients of interest. All patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code that was a potential indication for SNS system were included. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. Statistical tests used included the c2 and Fisher tests, as well as multivariate logistic regression analyses using SAS v9.3 (SAS Institute Inc., Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY). RESULTS: A total of 3,198,300 patients were identified with a diagnosis that could potentially be treated with SNS. Of these patients, 14,780 patients underwent treatment with SNS (0.46%). The percentage of patients diagnosed who ultimately underwent treatment increased from 0.02% to 0.75% (p <0.001) over the 10-year study period. On logistic regression analysis, women (OR1⁄44.60, p<0.0001) and patients aged less than 65 years (OR1⁄41.00, compared to older age groups OR1⁄40.29-0.44, p<0.0001) were more likely to be treated with SNS. Non-white individuals (OR1⁄40.48, p<0.0001) and those living in the western U.S. (OR1⁄40.55, p<0.0001) were less likely to receive surgical treatment (see Table). CONCLUSIONS: The usage of SNS among patients diagnosed with a potential indication has significantly increased among Medicare beneficiaries over a 10-year period. Patients were more likely to be treated with SNS if they were female, white, were <65 years of age, and lived outside of the west coast of the U.S. Knowledge of these data might promote more equal access to SNS nationwide.

383 Sonography tape characteristic and incontinence outcome after trans-obturator tape (TOT) surgery

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) (InterStim , Medtronic, Inc., Minneapolis, MN) has been used as a second-line therapy for both urinary and bowel control. There is limited data in the literature regarding trends of utilization of SNS to explore precisely who is treated with SNS. We sought to explore disparities in the utilization of SNS among Medicare beneficiaries. METHODS: A 5% national random sample of all Medicare claims for 2001, 2004, 2007, and 2010 was queried to identify patients of interest. All patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code that was a potential indication for SNS system were included. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. Statistical tests used included the c2 and Fisher tests, as well as multivariate logistic regression analyses using SAS v9.3 (SAS Institute Inc., Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY). RESULTS: A total of 3,198,300 patients were identified with a diagnosis that could potentially be treated with SNS. Of these patients, 14,780 patients underwent treatment with SNS (0.46%). The percentage of patients diagnosed who ultimately underwent treatment increased from 0.02% to 0.75% (p <0.001) over the 10-year study period. On logistic regression analysis, women (OR1⁄44.60, p<0.0001) and patients aged less than 65 years (OR1⁄41.00, compared to older age groups OR1⁄40.29-0.44, p<0.0001) were more likely to be treated with SNS. Non-white individuals (OR1⁄40.48, p<0.0001) and those living in the western U.S. (OR1⁄40.55, p<0.0001) were less likely to receive surgical treatment (see Table). CONCLUSIONS: The usage of SNS among patients diagnosed with a potential indication has significantly increased among Medicare beneficiaries over a 10-year period. Patients were more likely to be treated with SNS if they were female, white, were <65 years of age, and lived outside of the west coast of the U.S. Knowledge of these data might promote more equal access to SNS nationwide.

Role of phytotherapy associated with antibiotic prophylaxis in female patients with recurrent urinary tract infections

OBJECTIVE Aim of this study is to evaluate the efficacy of a phytotherapic which includes Solidago, Orthosiphon and Birch extract (Cistimev®) in association with antibiotic prophylaxis in female patients affected by recurrent urinary tract infections (UTIr). MATERIALS AND METHODS Patients affected by UTIr older than 18 years started a 3-months antibiotic prophylaxis (Prulifloxacin 600 mg, 1 cps/week or Phosphomicyn 1 cachet/week) according to antibiogram after urine culture. The patients were divided in 2 groups: Group A: antibiotic prophylaxis plus phytotherapy (1 cps/die for 3 months) and Group B: antibiotic prophylaxis alone. RESULTS 164 consecutive patients were studied: 107 were included in group A (mean age 59 ± 17.3 years) and 57 (mean age 61 ± 15.7) in group B. During the treatment period the relapse frequencies between the two groups were not significantly different (p = 0.854): 12/107 (11.21%) patients interrupted the treatment for UTIr in group A and 6/57 (10.52%) in group B. In the long term follow-up the relapse UTI risk was significant different in the two groups with a relapse risk 2.5 greater in group B than in group A (p < 0.0001). CONCLUSION Our study demonstrated that in female patients affected by recurrent UTI, the association between antibiotic prophylaxis and of a phytotherapic which includes Solidago, Orthosiphon and Birch extract reduced the number of UTI in the 12 months following the end of prophylaxis and obtained a longer relapsing time, greatly improving the quality of life of the patients.

287 COST-UTILITY RATIOS (CURS) AND DIFFERENT LEVELS OF EFFECTIVENESS IN URINARY INCONTINENCE (UI) MANAGEMENT

impact that ‘never events’ had on mortality, length of stay (LOS), and total hospital charges was determined. RESULTS: The overall rate for ‘never event’ was 8.2%. Most common were SSI (3.7%), DVT/PE (2.7%), and vascular-catheter infection (1.3%). Demographics that predicted ‘never events’ included black race (OR 1.5, 95% CI 1.3 – 1.8), increasing age (OR 1.01, 95% CI 1.00 – 1.01), comorbidities (OR 1.3, 95% CI 1.1 – 1.5), Medicare insurance (OR 1.3, 95% CI 1.2 – 1.4). ‘Never event’ rate was decreased in females (OR 0.8, 95% CI 0.7 – 0.9), urban nonteaching hospitals (OR 0.7, 95% CI 0.6 – 0.8) and high cystectomy volume hospitals (OR 0.8, 95% CI 0.7 – 0.9). ‘Never events’ increased average LOS (by 13 days), total charges (by

Prulifloxacin vs fosfomycin for prophylaxis in female patients with recurrent UTIs: a non-inferiority trial

80,000), and odds of in-hospital mortality (9.7% vs. 1.8%). CONCLUSIONS: ‘Never events’ are more likely in older patients with more comorbidities. Developing a ‘never event’ strongly predicts negative patient outcomes including higher LOS, charges, in-hospital mortality. High-risk populations may benefit from a case risk adjustment process prior to implementing a significant alteration in hospital or physician reimbursement policies.