Overactive bladder syndrome (OAB) is defined by urinary urgency, usually accompanied by increased frequency and nocturia, with or without incontinence. It is a disease with significant social impact due to its high prevalence, which increases with age, and its impairment on quality of life. It affects about 16.9% of women, potentially reaching up to 30.9% in those over 65 years old. The pharmacological treatment of OAB is carried out using anticholinergics and beta-3 agonists, which have similar efficacy but present different side effects, contraindications, and costs, which can interfere with treatment adherence and physicians' choice of medication. Regarding anticholinergics, it is also necessary to consider the concept of cholinergic load and the cumulative effect of these drugs, especially on the central nervous system. Studies have already shown a positive association between anticholinergic use and the development of dementia. The objective of this study was to compare the pattern and reasons for prescribing medications for OAB, as well as the knowledge of the mechanisms of action, efficacy, and safety among healthcare professionals from different specialties.

A cross-sectional study was conducted, including gynecologists, urologists, and urogynecologists. Participants answered an electronic questionnaire with 20 questions about the most prescribed drugs and the professionals' knowledge about them.

A total of 100 professionals responded to the questionnaire. Regarding the sample profile, 60% of the professionals were male, the majority were between 30 and 40 years old (30%), and over 40% had completed their undergraduate studies more than 20 years ago. Within the evaluated sample, the vast majority reported prescribing drugs for OAB treatment in their practice (89%). Most of the interviewed doctors reported prescribing solifenacin as the first choice of treatment (43%). Comparing the prescription of each specialty, solifenacin was preferred by both urologists (33%) and urogynecologists (58%). Gynecologists, on the other hand, chose oxybutynin as their first option (37%). A socioeconomic analysis was also conducted, with 42% of the respondents predominantly working in public healthcare. In this context, the most prescribed drug by professionals from public hospitals was oxybutynin (40%). Regarding the evaluation of the cholinergic load of medications, 61% of the professionals stated knowing the concept, with 89% of the respondents correctly identifying oxybutynin as the drug that most crosses the blood-brain barrier, and 56% recognizing Trospium as the one with the least effect. Additionally, professionals opted to change their first-choice drug response when a segment of the population over 65 years old with dementia was considered, with mirabegron becoming the most prescribed drug in this situation (56%). As for contraindications to the use of anticholinergics, some were better known, such as closed-angle glaucoma, recognized by 90% of the respondents. Dementia, however, was identified as a contraindication to the use of anticholinergics by only 63% of the professionals. In comparison, contraindications to beta-3 agonist use were less known: arrhythmia was recalled by only 33% of the professionals, and decompensated hypertension by 57%.

The results of this study showed a difference in the pattern of prescribing pharmacological treatment for patients with OAB, with gynecologists prescribing more oxybutynin while urogynecologists and urologists prescribing more solifenacin. Oxybutynin, being available for a longer time, may be better known to professionals who do not directly work with the disease. It was also the most prescribed drug among professionals working in the public healthcare system, noting that this is the least expensive medication on the market. In this study, less than half of the professionals prescribing these medications were familiar with the concept of cholinergic load (39% of the professionals surveyed). This result is consistent with previously conducted studies where the described rate was 37%. Despite this, professionals showed concern about the repercussions of anticholinergic use on cognitive decline, with the majority starting to prescribe beta-3 adrenergics for these cases. Despite these knowledge gaps about prescribed medications, 89% of the respondents reported using these medications for OAB treatment in their practice, indicating a need to assess the associated risks of using these drugs.

There is a discrepancy in the pattern of prescribing medications for patients with OAB, with gynecologists preferring oxybutynin and urogynecologists/urologists opting more for solifenacin. There are knowledge gaps regarding the mechanism of action, contraindications, and adverse effects of the various drugs among specialties. The concept of cholinergic load is known to the minority of professionals who reported prescribing anticholinergics in their clinical practice, but there is some knowledge and concern about their effects on the central nervous system.