Urinary Incontinence Care Varies by Specialty

The number of urinary incontinence visits has increased from 10.7 million to 13.6 million since 1999.
The number of urinary incontinence visits has increased from 10.7 million to 13.6 million since 1999.

Medical specialties vary considerably in their management of urinary incontinence (UI) in women, despite the availability of UI treatment guidelines, new study findings suggest.

In addition, the study showed that most women do not have their type of UI categorized and urinalysis is underused.

Researchers at Weill Cornell Medical College/New York Presbyterian Hospital in New York led by Bilal Chughtai, MD, analyzed 1999–2010 data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medicare Care Survey. They identified visits by adult female patients to physician practices or hospital outpatient departments where UI was the chief complaint or primary diagnosis.

The number of UI visits increased from 10.7 million in 1999–2000 to 13.6 million in 2009–2010.

Overall, the use of antimuscarinic agents increased significantly from 16.7% of UI visits in 1999–2000 to 35% in 2009–2010. Urinalysis use decreased significantly from 53% of cases in 1999–2000 to 37.2% in 2009–2010.

The investigators examined trends in the management of UI by physician specialty: primary care doctors, urologists, and gynecologists. Antimuscarinic use among gynecologists was less than that of the other specialties.

Data showed that antimuscarinic use among primary care doctors rose from 24.9% of cases in 1999–2000 to 42.4% in 2009–2010, a trend that was not statistically significant. Urologists' use of antimuscarinic agents rose significantly from 23.5% of cases in 1999–2000 to 44.2% in 2009–2010. Gynecologists used antimuscarinics in 10% of cases in 1999–2000 and 25.3% in 2009–2010.

Urinalysis use by primary care doctors declined from 49.7% of cases in 1999–2000 to 19.5% in 2009–2010. Urinalysis use by urologists decreased from 81.1% in 1999–2000 to 63.7% in 2009–2010. Urinalysis use by gynecologists decreased from 50.6% of cases in 1999–2000 to 29.4% in 2009–2010.

The increase in antimuscarinic use, Dr. Chughtai noted, may be due to the fact that these medications are more widely available and marketed and more practitioners are aware of these drugs.

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