RESUMEN
BACKGROUND: Neurogenic bladder (NB) is a prevalent urologic condition significantly impacting the health and quality of life of affected individuals. The condition, often resulting from various etiologies such as spinal cord injuries and multiple sclerosis, leads to severe life problems, including pain and impaired physical, mental, social, and emotional functioning. This study aims to explore the medical practices of urologists in the diagnosis, management, and care of NB patients within the Palestinian healthcare context, highlighting the absence of a unified treatment protocol and the reliance on private clinics for care. METHODS: An exploratory qualitative study design was employed, adhering to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Structured interviews were conducted with 14 urologists and two urology residents across eight different cities in Palestine, including 10 governmental hospitals, two private hospitals, one university hospital, and one charity hospital. Fourteen doctors had private outpatient clinics alongside their work in hospitals. A questionnaire developed by the authors was delivered to specialists and residents to understand the evaluation, management, follow-up practices, and challenges faced in treating NB patients. The study focused on the diagnostic processes, treatment modalities, complications management, and the impact of the lack of standardized protocols on patient care. Our qualitative study consists of six major themes, each theme consisting of multiple sub-themes and different participant responses: (1) diagnosis and follow-up of NB patients; (2) general issues in the management of NB; (3) evaluation and follow-up of upper and lower urinary system function in NB patients; (4) urinary tract infections associated with NB disease and how to deal with it; (5) opinions and future attitudes in the treatment of NB patients; (6) NB in patients with multiple sclerosis. RESULTS: The study found that urodynamic studies are crucial in NB diagnosis, yet there is no unified management protocol, leading to varied practices. Most participants preferred the American Urological Association (AUA) guidelines in the absence of Palestinian protocols. Six major themes emerged, including diagnosis and follow-up challenges, general issues in NB management, evaluation and follow-up of urinary system function, urinary tract infections management, opinions on future treatment directions, and specific considerations for NB patients with multiple sclerosis. CONCLUSIONS: The study highlights the need for a unified, standardized protocol for the management of NB patients in Palestine. The reliance on international guidelines, primarily the AUA protocols, underscores the gap in local healthcare policies. The findings call for the establishment of national guidelines and enhanced resources for the effective management of NB, aiming to improve patient outcomes and quality of life.
RESUMEN
BACKGROUND: Overactive bladder (OAB) is a popular distressing health condition that has negative impact on health-related quality of life (HRQoL) of the inflicted individuals. This multicenter study was conducted to determine the prevalence of OAB symptoms and their impact on the HRQoL of medical and dentistry students. METHODS: This study was conducted in a cross-sectional design in the 3 main universities in Palestine. In addition to the sociodemographic, health, and academic characteristics of the medical and dentistry students, the questionnaire also contained the OAB symptom bother (6-items) and HRQoL (13-items) Short-Form (OAB-q SF) scales. Kruskal-Wallis test, Mann-Whitney U test, Pearson Chi-Square/Fisher's Exact Test, Spearman's rank correlations, and a multiple linear regression model were used to analyze the data. RESULTS: Responses were collected from medical and dentistry students (n = 402). The median OAB symptom bother score was 54.1 [44.8, 81.9] and the median HRQoL score was 94.4 [88.4, 94.4]. There was a strong negative correlation between the OAB and HRQoL scores (Spearman's rho = 64.4%, p value < 0.001). OAB scores were significantly higher among dentistry students, females, who had chronic disease, and those who reported stressful life. HRQoL scores were significantly higher among medicine students, those who reported less stressful life, and those who reported satisfaction with their social life. Dentistry students, female, and those who self-reported high stress were 1.94-fold (95% CI 1.05, 3.56), 1.91-fold (95% CI 1.16, 3.14), and 1.88-fold (95% CI 1.21, 2.91) more likely to report less than optimal HRQoL compared to medicine students, male, and those who self-reported low stress, respectively. CONCLUSIONS: Our findings suggested that OAB symptoms were prevalent among medical and dentistry students across Palestinian universities. Decision makers in academia, healthcare authorities, and advocacy groups might need to design appropriate interventions to address health and wellbeing issues of medical and dentistry students. Using appropriate diagnostic procedures, reducing stress, and improving the social life might help in reducing the burden on OAB and improve the HRQoL of medical and dentistry students. More investigations should be conducted to investigate if such interventions are effective in reducing OAB symptoms and improving HRQoL.