title: Urologists' referral attitude for sacral neuromodulation for treating refractory idiopathic overactive bladder syndrome: discrete choice experiment.
abstract: OBJECTIVE
  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.
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.forename: Angelina
authors.initials: A
authors.lastname: Maric
authors.forename: Livio
authors.initials: L
authors.lastname: Mordasini
authors.forename: Jens
authors.initials: J
authors.lastname: Wöllner
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mehnert
authors.forename: Philip E
authors.initials: PE
authors.lastname: van Kerrebroeck
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D000075202:Contraindications; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013577:Syndrome; D053201:Urinary Bladder, Overactive / Q000628:therapy*; D014572:Urology
keywords: discrete-choice experiment; overactive bladder syndrome; sacral neuromodulation; vignette study