Overactive bladder (OAB) is associated with urinary incontinence and significantly reduces quality of life among the patients.(1) Although anticholinergics and β3-receptor stimulants are available as therapeutic agents, and only about half of the patients with OAB respond adequately to oral medications alone, and satisfaction with the OAB treatment has been reported to be low.(2) Previous studies have evaluated various factors associated with satisfaction with OAB treatment.(3) However, gender-focused approach toward OAB treatment satisfaction has not been fully explored. In women, it may be more difficult than in men to appropriately communicate symptoms to their physicians due to embarrassment, and having a female doctor in charge of female patients may increase their treatment satisfaction.

The primary goal of this study was to determine whether the gender combination of patient and physician may be associated with satisfaction with OAB treatment.
This questionnaire survey was conducted at a hospital in Japan. The hospital has the daily outpatient visit of around 100 patients. We considered the adult patients aged 18 years or older who attended the outpatient office of the urology department of the hospital, were diagnosed with overactive bladder, and had been taking anticholinergics or β3-receptor stimulants, or both, for at least 3 months. 
Our team developed the questionnaire referring to the previous studies covering this topic.(3) The questionnaire was distributed to eligible patients between November 2020 and March 2021, and those unwilling to participants and those unable to complete the questionnaire on their own due to cognitive decline or visual impairment were excluded. In addition to the OAB treatment satisfaction, the questionnaire covered Overactive Bladder Symptom Scale (OABSS), International Prostate Symptom Score (IPSS), oral medications, effectiveness of OAB treatment, response to OAB symptoms, and the medium and extent of information collection.

In the analysis, our primary outcome measure was OAB treatment satisfaction. In accordance with previous studies,(3) we used the question of OAB treatment satisfaction to explore this outcome. This variable was transformed into a dichotomous measure (satisfied or other) for the following analyses. We coded the “other” response as the base outcome. First, univariate analyses were conducted using all variables as covariates and followed by multivariate analyses for significant factors. The main interest was the doctor-patient gender combination, which was categorized as male-male, female-female, and other combinations, and was forced into the final model. 

A total of 147 patients participated in the study. In summary, 91 (61.9%) were male and the mean age was 73.5 years (standard deviation 9.9 years). Table 1 shows findings of the multivariable logistic regression analysis of the OAB treatment satisfaction. Compared to when the gender of doctor and patient was not the same, female patients tended to be significantly more satisfied when they were treated by female doctors (odds ratio 10.79, 95% confidence interval 1.27-92.05). On the other hand, no similar trend was observed when male patients were treated by male doctors (odds ratio 1.26, 95% confidence interval 0.25-6.34).

In the present study, which examined doctor-patient gender combinations in satisfaction with OAB treatment, as hypothesized, satisfaction was higher for female doctor-female patient combinations compared to different doctor-patient genders. This is an extremely important finding for the future of overactive bladder (OAB) treatment in Japan, as there have been no similar studies.

A notable fact was that similar associations were not observed among the male doctor-patient combination. This means that an embarrassment of female patients could be stronger than male patients particularly in disclosing urinary symptoms to healthcare providers. In Japan, it is estimated that female OAB patients account for 10.8% of those over 40 years of age, but less than half of them reportedly seek medical consultation. Further, the main reason for such avoidance is speculated to be embarrassment. The percentage of female urologists in Japan is only 8.2%, and it will be necessary to further promote the recruitment of female doctors in urology fields in order to encourage female patients with OAB to more actively visit doctors. Limitations of the study include a small sample size.

In the present study, which examined doctor-patient gender combinations in satisfaction with OAB treatment, as hypothesized, satisfaction was higher for female doctor-female patient combinations compared to different doctor-patient genders. This is an extremely important finding for the future of overactive bladder (OAB) treatment in Japan, as there have been no similar studies.

1.	Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Urology. 2003; 61: 37–49.
2.	Seinen A, Elburg R, Hollegien L, Blanker M, Witte L. The patient pathway for overactive bladder management: A quantitative analysis Neurourol Urodyn. 2022; 41: 290-295.
3.	Akino H, Namiki M, Suzuki K et al. Factors influencing patient satisfaction with antimuscarinic treatment of overactive bladder syndrome: Results of a real-life clinical study Int J Urol. 2014; 21: 389–394

Continence 12S (2024) 101565
DOI: 10.1016/j.cont.2024.101565