Study Type – Therapy (prevalence) Level of Evidence 2b What's known on the subject? and What does the study add? Persistence with long‐term medication in chronic diseases is typically low and that for overactive bladder medication is lower than average. Sub‐optimal persistence is a major challenge for the successful management of overactive bladder. Using UK prescription data, persistence was generally low across the range of antimuscarinics. Patients aged 60 years and above were more likely to persist with prescribed oral antimuscarinic drugs than younger patients (40–59 years). Solifenacin was consistently associated with the highest rate of persistence compared with the other antimuscarinics included in the study OBJECTIVES To describe the level of persistence for patients receiving antimuscarinics for overactive bladder (OAB) over a 12‐month period based on real prescription data from the UK. To investigate patterns of persistence with oral antimuscarinic drugs prescribed for OAB, across different age groups. PATIENTS AND METHODS UK prescription data from a longitudinal patient database were analysed retrospectively to assess persistence with darifenacin, flavoxate, oxybutynin (extended release [ER] and immediate release [IR]), propiverine, solifenacin, tolterodine (ER/IR) and trospium. Data were extracted from the medical records of >1 200 000 registered patients via general practice software, and anonymized prescription data were collated for all eligible patients with documented OAB (n= 4833). Data were collected on patients who started treatment between January 2007 and December 2007 and were collected up to December 2008, to allow each patient a full 12‐month potential treatment period. Failure of persistence was declared after a gap of at least 1.5 times the length of the period of the most recent prescription. The analysis included only patients who were new to a course of treatment (i.e. who had not been prescribed that particular treatment or dosage for at least 6 months before the study period). RESULTS The number of patients prescribed each antimuscarinic drug varied from 23 for darifenacin to 1758 for tolterodine ER. The longest mean persistence was reported for solifenacin (187 days versus 77−157 days for the other treatments). At 3 months, the proportions of patients still on their original treatment were: solifenacin 58%, darifenacin 52%, tolterodine ER 47%, propiverine 47%, tolterodine IR 46%, oxybutynin ER 44%, trospium 42%, oxybutynin IR 40%, flavoxate 28%. At 12 months, the proportions of patients still on their original treatment were: solifenacin 35%, tolterodine ER 28%, propiverine 27%, oxybutynin ER 26%, trospium 26%, tolterodine IR 24%, oxybutynin IR 22%, darifenacin 17%, flavoxate 14%. In a sub‐analysis stratified by age, patients aged ≥60 years were more likely to persist with prescribed therapy over the 12‐month period than those aged <60 years. CONCLUSIONS Twelve months after the initial prescription, persistence rates with pharmacotherapy in the context of OAB are generally...

* At the time of this consultation, these definitions are not included in the current ICS terminology. RECOMMENDATIONS OF THE INTERNATIONAL SCIENTIFIC COMMITTEE 2. EVALUATION The following phrases are used to classify diagnostic tests and studies: • A highly recommended test is a test that should be done on every patient. This section should also be read in conjunction with the relevant committee reports. RECOMMENDATIONS OF THE INTERNATIONAL SCIENTIFIC COMMITTEE 6. ANORECTAL PHYSIOLOGY TESTING Endocoil MRI has high accuracy for detecting anal sphincter injury but is second line after endoanal ultrasound. Patients with faecal incontinence may benefit from assessment with MRI, particularly those with anorectal malformations and/or previous anal sphincter surgery. Defaecography may be useful and is recommended in patients with faecal incontinence, who have failed conservative therapies, and are possible candidates for laparoscopic ventral rectopexy. * Consider CONTINENCE PRODUCTS for temporary support during treatment Recent VVF Primary simple Consider Catheter, evaluate weekly Established VVF Primary complex Healed Persistant leakage Recurrence Post-irradiation Vaginal repair Consider timing Surgical repair Consider timing Consider interposition material If small, consider catheter, evaluate weekly Surgical repair 6-12 months Consider interposition material Surgical repair Consider timing Consider interposition material Assess fistula closure & assess continence status MANAGEMENT OF IATROGENIC URETERIC FISTULAE HISTORY CLINICAL ASSESSMENT MANAGEMENT* PRESUMED DIAGNOSIS Extra-urethral vaginal urinary leakage and/or signs of ureteric obstruction Clinical examination Urethro-cystoscopy Imaging (Xray/CT/ MRI, US) Evaluate upper urinary tract obstruction * Consider CONTINENCE PRODUCTS for temporary support during treatment Ureterovaginal fistula Endoluminal technique (stenting, nephrostomy) for at least 6 weeks Unable to stent (initially)... Re-evaluate for fistula closure, ureteric obstruction Persisting fistula or ureteric obstruction Ureteric reimplantation (open, laparoscopic or robotic) Healed Long-term follow-up for stricture and hydropephrosis * Consider CONTINENCE PRODUCTS for temporary support during treatment Patient education, adequate fibre diet and fluid intake; regular bowel care, preferably ± 3 times a week

This study assessed persistence and adherence (or compliance) with medications prescribed for OAB in a large UK population. We found that patients prescribed mirabegron remained on treatment for longer and showed greater adherence than those prescribed traditional antimuscarinics.

Aims: In this review we try to shed light on the following questions:. How frequently are symptoms of overactive bladder (OAB) and is detrusor overactivity (DO) present in patients with pelvic organ prolapse (POP) and is there a difference from women without POP? . Does the presence of OAB symptoms depend on the prolapsed compartment and/or stage of the prolapse? . What is the possible pathophysiology of OAB in POP? . Do OAB symptoms and DO change after conservative or surgical treatment of POP?Methods: We searched on Medline and Embase for relevant studies. We only included studies in which actual data about OAB symptoms were available. All data for prolapse surgery were without the results of concomitant stress urinary incontinence (SUI) surgery. Results: Community-and hospital-based studies showed that the prevalence of OAB symptoms was greater in patients with POP than without POP. No evidence was found for a relationship between the compartment or stage of the prolapse and the presence of OAB symptoms. All treatments for POP (surgery, pessaries) resulted in an improvement in OAB symptoms. It is unclear what predicts whether OAB symptoms disappear or not. When there is concomitant DO and POP, following POP surgery DO disappear in a proportion of the patients. Bladder outlet obstruction is likely to be the most important mechanism by which POP induces OAB symptoms and DO signs. However, several other mechanisms might also play a role. Conclusions: There are strong indications that there is a causal relationship between OAB and POP.

Introduction: Antimuscarinics are the principal pharmacological treatment for overactive bladder (OAB), but frequently give rise to anticholinergic side effects, such as dry mouth, a factor leading to poor persistence. The ß 3 -adrenoceptor agonist mirabegron is devoid of significant anticholinergic activity, while being effective in OAB. We evaluated persistence and adherence with mirabegron versus antimuscarinics over 12 months. Methods: We obtained retrospective claims from a Canadian Private Drug Plan database for patients 18 years old and over, with a first claim for mirabegron or antimuscarinics during a 6-month index period (April-September 2013). A 6-month look-back identified those with no prior claims for OAB medication (treatmentnaïve) or ≥1 prior OAB drug (treatment-experienced). Time to end of persistence (≥30 day therapy gap or switch of therapy) was evaluated over 12 months; adherence with medication (medication possession ratio) was also measured. Results: Persistence data from 19 485 patients (74% female, 92% naïve, 19.9% aged ≥65 years) showed that for experienced patients the median number of days on mirabegron was 299 days, compared with a range of 96 to 242 days for the different antimuscarinics; for naïve patients, it was 196 versus 70 to 100 days, respectively. Persistence at 12 months was for mirabegron 39% versus 14% to 35% for antimuscarinics, (experienced) and 30% mirabegron versus 14% to 21% antimuscarinics, (naïve). Patients taking mirabegron demonstrated statistically significantly greater adherence than those taking antimuscarinics. Conclusion: Patients who received mirabegron remained longer on treatment than those treated with antimuscarinics, and had higher 12-month persistence and adherence rates.