Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder | Actas Urológicas Españolas (English Edition)

array:23 ["pii" => "S2173578614000262" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2014.02.010" "estado" => "S300" "fechaPublicacion" => "2014-05-01" "aid" => "611" "copyright" => "AEU" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2014;38:209-16" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 454 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 311 "PDF" => 136 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480613004191" "issn" => "02104806" "doi" => "10.1016/j.acuro.2013.12.002" "estado" => "S300" "fechaPublicacion" => "2014-05-01" "aid" => "611" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2014;38:209-16" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 781 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 533 "PDF" => 240 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Artículo especial" "titulo" => "Consenso experto sobre la evidencia científica disponible acerca del uso de toxina botulínica en vejiga hiperactiva" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "216" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1391 "Ancho" => 3094 "Tamanyo" => 268115 ] ] "descripcion" => array:1 [ "es" => "Esquema del desarrollo del método Delphi modificado." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Esteban, J. Salinas, S. Arlandis, J. Díez, M. Jiménez, M. Rebassa, J.C. Angulo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Esteban" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Salinas" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Arlandis" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Díez" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Jiménez" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Rebassa" ] 6 => array:2 [ "nombre" => "J.C." "apellidos" => "Angulo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578614000262" "doi" => "10.1016/j.acuroe.2014.02.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000262?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480613004191?idApp=UINPBA00004N" "url" => "/02104806/0000003800000004/v1_201404250112/S0210480613004191/v1_201404250112/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173578614000213" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2014.02.005" "estado" => "S300" "fechaPublicacion" => "2014-05-01" "aid" => "583" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2014;38:217-23" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 594 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 476 "PDF" => 109 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Optimizing prostate cancer screening; prospective randomized controlled study of the role of PSA and PCA3 testing in a sequential manner in an opportunistic screening program" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "217" "paginaFinal" => "223" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Optimización de un programa de cribado oportunista de cáncer de próstata; ensayo aleatorizado prospectivo del papel del PSA y del PCA3 en uso secuencial" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2656 "Ancho" => 2570 "Tamanyo" => 396259 ] ] "descripcion" => array:1 [ "en" => "Results of the study. Abbreviations: Gl. Gleason score; IBx, initial biopsy; PSA, prostate-specific antigen; RE, rectal examination." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Rubio-Briones, J. Casanova, R. Dumont, L. Rubio, A. Fernandez-Serra, I. Casanova-Salas, J. Domínguez-Escrig, M. Ramírez-Backhaus, A. Collado, A. Gómez-Ferrer, I. Iborra, J.L. Monrós, J.V. Ricós, E. Solsona, D. Salas, F. Martínez, J.A. Lopez-Guerrero" "autores" => array:17 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Rubio-Briones" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Casanova" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Dumont" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Rubio" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Fernandez-Serra" ] 5 => array:2 [ "nombre" => "I." "apellidos" => "Casanova-Salas" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "Domínguez-Escrig" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Ramírez-Backhaus" ] 8 => array:2 [ "nombre" => "A." "apellidos" => "Collado" ] 9 => array:2 [ "nombre" => "A." "apellidos" => "Gómez-Ferrer" ] 10 => array:2 [ "nombre" => "I." "apellidos" => "Iborra" ] 11 => array:2 [ "nombre" => "J.L." "apellidos" => "Monrós" ] 12 => array:2 [ "nombre" => "J.V." "apellidos" => "Ricós" ] 13 => array:2 [ "nombre" => "E." "apellidos" => "Solsona" ] 14 => array:2 [ "nombre" => "D." "apellidos" => "Salas" ] 15 => array:2 [ "nombre" => "F." "apellidos" => "Martínez" ] 16 => array:2 [ "nombre" => "J.A." "apellidos" => "Lopez-Guerrero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480613003331" "doi" => "10.1016/j.acuro.2013.09.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480613003331?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000213?idApp=UINPBA00004N" "url" => "/21735786/0000003800000004/v1_201405090042/S2173578614000213/v1_201405090042/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "216" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Esteban, J. Salinas, S. Arlandis, J. Díez, M. Jiménez, M. Rebassa, J.C. Angulo" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Esteban" "email" => array:1 [ 0 => "ESTEBOTE@telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Salinas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Arlandis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Rebassa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "J.C." "apellidos" => "Angulo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urología, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Urología, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Urología, Hospital Son Llàtzer, Palma de Mallorca, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Consenso experto sobre la evidencia científica disponible acerca del uso de toxina botulínica en vejiga hiperactiva" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3580 "Ancho" => 3167 "Tamanyo" => 910957 ] ] "descripcion" => array:1 [ "en" => "Issues proposed to the expert panel on the role of botulinum toxin in the overactive bladder and the results from the 2nd round (disagreement, no consensus and agreement). To the right, the degree of consensus reached on the same issues is represented graphically." ] ] ] "textoCompleto" => "BackgroundOveractive bladder (OAB) has been defined since 2002 as the onset of urinary urgency, with or without urge incontinence, which can be accompanied by frequent urination and/or nocturia, provided other concomitant urinary tract diseases such as infection or lithiasis have been ruled out.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Its etiology is unknown but could be multifactorial and include nervous system (central and peripheral) or bladder muscle abnormalities.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> OAB has a high prevalence that increases with age. In Spain, OAB affects approximately 21.5% of the population over 40 years of age and approximately 30% of individuals older than 75 years, affecting men and women similarly.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> European and American epidemiological studies have revealed a similar epidemiology.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> Hu et al. estimated the financial cost of OAB in the US at more than 9 billion dollars annually, with more than 1 billion for the treatment of associated urinary infections. This does not take into account the costs due to loss of productivity and unquantifiable losses.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The negative impact is also apparent in the patients’ quality of life due to the shame, frustration, anxiety, depression, sexual dysfunction, physical-psychological impairment, insomnia and urinary tract and skin infections resulting from OAB.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Fifty-three percent of patients with OAB report that their symptoms are truly bothersome.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Treatment for OAB is usually based on dietary changes, fluid restriction, bladder training, pelvic physical therapy, biofeedback, electrical stimulation and drug therapy (anticholinergic agents as first-line treatment and beta-adrenergic agonists). Anticholinergic drugs often have adverse effects (dry mouth, blurred vision and cognitive changes), which do not occur with beta agonists,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and the extended use of anticholinergic drugs decreases their efficacy. Other vanilloid drugs (capsaicin and resinferatoxin) are under development.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Onabotulinum toxin A (OnabotA) has proven to be a therapeutic alternative in patients with refractory OAB, due to its ability to reversibly block motor and sensory nerve transmission by inhibiting the release of acetylcholine (efferent) and other neurotransmitters that participate in afferent signaling.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> This mechanism of action could explain the motor effect in the relaxation of the detrusor muscle and its sensory effect, such as the feeling of urgency.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>In fact, the intravesical injection of OnabotA is increasingly used as an intervention for refractory OAB.<a class="elsevierStyleCrossRefs" href="#bib0065">13–19</a> The efficacy and safety of OnabotA has been demonstrated in 4 phase 3 trials, in the treatment of both neurogenic<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> and idiopathic OAB.<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a> The optimal dose in the treatment of neurogenic OAB is 200U, which reduces the number of incontinence episodes in week 6 of the therapy by 100% in 37% of patients and by 50% in 76% of the patients.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> The optimal recommended dose in the treatment of idiopathic OAB is 100U. In this case, the treatment reduced the number of incontinence episodes by 100% in 27.1% and by 50% in 60.5% of the patients included in the studies. The patients tolerated the treatment well; the most common adverse effects were urinary tract infection and urinary retention.<a class="elsevierStyleCrossRefs" href="#bib0100">20–24</a> Patients also showed significant improvements in quality of life according to standard scales.<a class="elsevierStyleCrossRefs" href="#bib0100">20–24</a>A cost-effectiveness study showed that OnabotA is more cost-efficient when compared with anticholinergic treatment over a 2-year period.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> Due to the cost and loss of efficacy of anticholinergic agents, the use of toxins has been proposed for first or second-line treatment in women with urinary incontinence. The double-blind, randomized ABC trial compared the efficacy of 100U of toxin versus anticholinergic agents in women treated for 6 months for moderate to serious urinary incontinence. The results of the trial favored OnabotA.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Although not accompanied by high levels of recommendation, expert consensus meetings are useful for clarifying new available evidence and facilitating the clinical management of patients in special conditions, as happens with the need for employing botulinum toxin in patients with OAB that is refractory to other treatments. These types of activities favor conceptual homogenization and decision making and attempt to unify the diagnostic and therapeutic criteria used in clinical practice.Materials and methodsFor the implementation of the study, we used the Delphi method modified by Lyn Paul.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Under the direction of a scientific committee, the study was performed in 4 phases. In the first phase, the committee proceeded with a structured review of the most recently published quality literature (in English and Spanish) on OAB in order to select the contents of questionnaires. A national panel of 43 experts was then selected and formed by urologists from various autonomous communities, with special interest and experience in functional bladder disorders and OAB syndrome (Appendix 1).In the second phase, the items for the survey were developed (professional criteria and clinical recommendations subjected to debate), using a previously employed, in-person, qualitative work procedure by the experts. The final version of the questionnaire included 93 items (see additional material attached), distributed in subject blocks as follows: 24 items on “the definition, classification, detection and differential diagnosis of OAB”, 27 items on “the medical treatment of OAB”, 20 items on “the surgical treatment of OAB” and 22 items on “the role of OnabotA in OAB”. The project's fieldwork was conducted between September 2012 and October 2012.The third phase (which was not in person but was performed by an independent technical team) consisted of the application of a modified Delphi method that requested the individual expert's anonymous opinion on the issue at hand through the completion of a structured written survey (sent by e-mail), in an anonymous and confidential manner. After this phase, there was a second round of surveys on the issues that failed to achieve consensus in the first round, providing the participants with the results obtained by the group in the first questionnaire, as well as the comments explaining their opinions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A single type of rating scale was proposed for all issues. The scale was a 9-point ordinal Likert scale (1=strongly disagree; 9=strongly agree), based on the format developed by UCLA-Rand Corporation for the assessment method for the appropriate use of health technology.<a class="elsevierStyleCrossRefs" href="#bib0140">28,29</a> The response categories are described by means of language qualifiers in 3 regions (1–3=“disagree”; 4–6=“neither agree nor disagree”; 7–9=“agree”).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The fourth phase corresponds to the collection and analysis of results. We used the median scores of the group and the level of correlation reached by the surveys, according to the following criterion: an item is considered agreed upon when there is an “agreement” of opinion on the panel, i.e., when the number of experts who score outside the 3-point region that contains the median ([1–3], [4–6], [7–9]) is less than a third of those surveyed. In such cases, the median value determines the group consensus: The majority “disagree” with the item, if the median is ≤3, or the majority “agree” with the item if the median is ≥7. Items for which the median was in the 4–6 region were considered “questionable”. Conversely, a “disagreement” of opinion was determined to exist in the panel when the scores of a third or more of the panelists were in the 1–3 region and another third or more in the 7–9 region. The remaining items on which there was no agreement or disagreement were considered to have an “indeterminate” level of consensus. All items on which the group did not reach a clear consensus in favor or against the issue raised (questionable items, those in which disagreement was observed and those with an indeterminate level of consensus) were proposed for reconsideration by the panel in the second Delphi around. Items with a high distribution of opinions among those surveyed, with an IQR≥4 points (scores within the Q1 and Q3 values of the distribution), were also submitted for reevaluation.The Delphi method provides several advantages including anonymity, which avoids the “effect of authority” related to the evidence generated by the opinion of experts. On the other hand, its potential drawbacks include the difficulties in properly selecting professional experts on the subject and the difficulties in preparing the questionnaire for reaching a consensus. These drawbacks are solved by the selection of representative panelists of recognized prestige and with the proper preparation of an appropriate questionnaire by an objective scientific committee. The bias associated with this type of study is thereby reduced.ResultsThe 42 experts completed 2 rounds of evaluation. Sufficient consensus was reached on 83 of the 93 items (89.25%), 78 (94%) agreed upon in terms of agreement with the statement, and the 5 remaining (6%) agreed upon in terms of rejection. In the first round, consensus was established for 64 of the 93 items. For the remaining 29 items proposed for reconsideration by the experts in the second round, consensus was achieved for 19 of the items. Ten of the items, however, did not achieve consensus, representing 10.75% of the opportunities for agreement in the overall series of statements and 34.5% of the opportunities for agreement in the second around.The supplementary material lists the overall results of the project, indicating for each item the centering statistic (median), the distribution rate for those surveyed who are located outside the region chosen by the majority and the interquartile range. The addendum also identifies whether the item was accepted or rejected by the panel to facilitate the reading of each item in the tables.Of the agreed-upon items, 9 achieved a median score of 9. Four of these issues corresponded to the definition, classification, detection and diagnosis block (questions 8, 13, 17 and 18). These items refer to the multifactorial etiology of OAB in the elderly, the urologist's role as responsible specialist for referrals of complex cases or for patients who respond poorly to initial treatment, as well as the role of the urodynamic study in patients with neurogenic bladder dysfunction, in OAB that does not response to treatment and in complex UI. Only one item corresponded to the medical treatment block (question 26), which concerns the 2 well-differentiated treatment levels for OAB: the initial (conservative treatment, antimuscarinic agents) and the specialized (neuromodulation, OnabotA, surgery, stimulation of the posterior tibial nerve). Another 2 items focused on the surgical treatment block (questions 52 and 71), specifying that an assessment of symptom intensity and their impact on quality of life should be conducted before second-line treatment is started and that surgery is clearly justified when OAB is due to an obstructive prolapse. The last 2 items focus on OnabotA (questions 72 and 83), highlighting that this treatment is an effective and safe alternative in OAB refractory to anticholinergic agents and that a urine sediment and culture test should be conducted for all cases before starting this treatment (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The items that, in addition to achieving a median score of 9, had no panelist in disagreement were questions 8, 26, 52 and 72. Three of these focused on second-line treatment and the issues related to the use of OnabotA.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Of all the content agreed upon in the questionnaire, 5 were expressly rejected by group consensus, 4 in the definition and diagnostic chapter and 1 in the medical treatment chapter. These items dealt with considerations such as “OAB has a proper definition for care”, “OAB screening tools are not needed”, “the frequency/volume sheet, the voiding diary and/or the urgency scale are dispensable” and “lifestyle change recommendations have low efficacy”. None of the statements or items regarding surgical treatment or use of OnabotA were rejected.Among the 10 proposals not agreed upon, 3 had majority but insufficient support from those surveyed. These were “detrusor hyperactivity does not determine better or worse response to treatment” (34.1% disagree), “onabotulinum toxin A can reverse refractoriness to antimuscarinic agents” (30.7% disagree) and “if the effect of onabotulinum toxin A decreases, its endovesical instillation may be considered” (only 12.5% disagree). The disagreement in expert opinion was also made clear by the fact that more than 35% of the panelists disagreed with the items concerning “the indication for pelvic floor muscle exercises”, “the low efficacy of antimuscarinic agents”, “the inappropriate handling of antimuscarinic agents in consultations”, “the lack of evidence in peripheral electrical stimulation”, “the scarcity of reference centers for neuromodulation can result in the undertreatment of refractory OAB”, “the list of essential and recommended tests before injecting toxins” or “whether repeated injections of toxin affects postvoid residual urine”. All of these issues reveal the disparity of professional opinion or a lack of criteria for the majority.DiscussionThe Delphi methodology is widely used in biomedicine and helps achieve professional consensus in a group of geographically dispersed experts. Successive rounds with processing and dissemination of interim result help achieve professional consensus, which results in the establishment of important recommendations aimed at decreasing variability in standard clinical practice. We have gathered relevant information about the main clinical controversies concerning the management of OAB and the indications and use of OnabotA. Specialists in this disease achieve a high degree of consensus on most issues and help establish the clinical positioning of this drug in the treatment of OAB.The panelists generally rejected the current definition of OAB due to its ambiguity, multiple origins and to the fact that it precludes potential organic diseases, thereby encouraging diagnoses that are often inaccurate, sometimes wrong and that lead to overtreatment.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> There is a consensus to include other aspects in the definition of OAB to avoid errors and to consider a third category of OAB secondary to other diseases. There is also consensus in terms of the prevalence, symptoms and epidemiology of OAB, which is consistent with internationally published data.<a class="elsevierStyleCrossRefs" href="#bib0150">30–32</a> The panelists also considered necessary the use of diagnostic screening tools and increased training in the disease, especially in primary care.<a class="elsevierStyleCrossRef" href="#bib0165">33</a>In terms of the clinical, diagnostic, therapeutic and prognostic differences associated with detrusor hyperactivity, it has been demonstrated that various treatments for OAB (pharmacological, neuromodulation and OnabotA) have an inhibitory effect not only on detrusor contractility (motor or efferent), but also on the afferent or sensory element (C fibers). Thus, the lack of an increase in the motor phenomenon such as detrusor hyperactivity would not preclude treatment.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>Based on the judgment of most panelists, the medical treatment of OAB must be individualized, phased and progressive due to its multiple etiology (neurogenic, muscle or other), severity and potential pharmacological contraindications. Treatment should start with conservative therapy, which should include pelvic floor muscle training for women. In terms of drug treatment based on antimuscarinic agents, the panelists reported low compliance and disagreement regarding the efficacy and clinical management.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> The associated causes were treatment intolerance, reported adverse events and the loss of efficacy after extended treatment.<a class="elsevierStyleCrossRefs" href="#bib0055">11,14,36</a> There are indeed significant variations in antimuscarinic treatment for patients with OAB.<a class="elsevierStyleCrossRef" href="#bib0185">37</a> Additionally, other issues such as the role of beta-adrenergic agonists (mirabegron)<a class="elsevierStyleCrossRefs" href="#bib0190">38,39</a> and even its possible combination with antimuscarinic agents,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> the night-time dosage of antimuscarinic agents and the combination with other drugs<a class="elsevierStyleCrossRef" href="#bib0200">40</a> also result in a lack of consensus on the results.In terms of the surgical treatment of OAB, there was broad consensus on the need to measure symptoms intensity and their repercussion on quality of life before starting second-line treatments. The OABQ-SF scale is probably the best questionnaire for assessment and follow-up.<a class="elsevierStyleCrossRef" href="#bib0205">41</a> For the treatment of refractory OAB, the use of OnabotA and sacral neuromodulation has been endorsed by various publications.<a class="elsevierStyleCrossRefs" href="#bib0210">42–44</a> Other techniques such as peripheral electrical stimulation (intravaginal or endoanal) and neuromodulation using TENS or SANS (posterior tibia) are simple and economic procedures.<a class="elsevierStyleCrossRef" href="#bib0225">45</a> Sacral neuromodulation is more complex and has a high financial cost.<a class="elsevierStyleCrossRef" href="#bib0230">46</a>The use of OnabotA in the treatment of OAB refractory to drugs stands as an effective and safe alternative.<a class="elsevierStyleCrossRefs" href="#bib0210">42,43</a> The approved dosage for neurogenic and idiopathic OAB is 200U and 100U, respectively.<a class="elsevierStyleCrossRefs" href="#bib0085">17,19,43</a> Another characteristic worth highlighting is its simple administration, which represents a significant advantage over sacral neuromodulation.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> OnabotA is also a cost-effective short to medium-term treatment when compared to drug treatment. Long-term OnabotA treatment is similar, and even superior, to sacral neuromodulation.<a class="elsevierStyleCrossRefs" href="#bib0125">25,26</a>ConclusionThe consensus achieved by a group of specialists closely matches the most recent scientific evidence on OAB. The panelists considered that a change in the current definition of OAB could be contemplated, due to its ambiguity and to its exclusion of other possible causes. The panelists also emphasized the need for improving screening tools. Finally, it is worth noting that medical treatment of OAB should be individualized, phased and progressive in relation to the various etiologies. Botulinum toxin A (Botox®) could have advantages when compared with other treatments and is a safe and effective alternative for treating OAB refractory to drugs.FundingAllegan S.A. provided support to the scientific committee and funded the study and tasks related to the Delphi survey.Conflicts of interestSpanish Urological Association sponsored the present project, in collaboration with Allergan S.A. Allergan S.A. has not participated in the design, data analysis or drafting of the present article. Luzán5 performed administrative support necessary for the implementation of this study, including the design, data collection and analysis.The authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres337394" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec318942" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres337395" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec318941" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-12-11" "fechaAceptado" => "2013-12-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec318942" "palabras" => array:5 [ 0 => "Overactive bladder" 1 => "Diagnosis" 2 => "Treatment" 3 => "Onabotulinumtoxin A" 4 => "Delphi method" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec318941" "palabras" => array:5 [ 0 => "Vejiga hiperactiva" 1 => "Diagnóstico" 2 => "Tratamiento" 3 => "Onabotulinumtoxin A" 4 => "Método Delphi" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectivesOveractive bladder (OAB) is a pathology impairing patients’ quality of life and with a high percentage of patients who are refractory to medication. In this paper, technical opinion of an «expert panel» is assessed in order to gain the most reliable professional consensus on scientific evidence available on the criteria for the use of Onabotulinumtoxin A (OnabotA) in OAB. Material and methodsAccording to DELPHI method, 42 panelists answered a survey of 93 items divided into four strategic areas including clinical criteria and recommendations in order to improve, at different levels, the current approach to patients with OAB. The recent advances in the field, areas of controversy and their real application possibilities in the different areas of our health care system were taken into consideration. ResultsTwo rounds of the questionnaire were completed by all experts. In the first round, a criteria consensus was reached for 64 of 93 (68.8%) questions analyzed; in the second round the consensus reached was for 83 items evaluated (89.25%). An agreement among panelists was reached for: (1) definition, classification, detection and differential diagnosis; (2) medical treatment; (3) surgical treatment; and (4) role of OnabotA in the treatment of OAB. ConclusionsThe consensus is broadly in line with the latest scientific evidence on OAB. The panelists believe that it is necessary to propose a change in the current definition of OAB and that it seems necessary to improve the screening tools too. Medical treatment of OAB must be tailored to each patient, staged and progressive. The use of OnabotA (Botox®) could imply therapeutic advantages with respect to other treatments, and positions itself as a safe and effective alternative to treat drug refractory OAB." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivosLa vejiga hiperactiva (VH) es una enfermedad que afecta negativamente la calidad de vida y con un porcentaje elevado de pacientes refractarios a la medicación. Se pretende explorar la opinión técnica de un panel experto y alcanzar consenso en el criterio profesional en relación con la evidencia científica disponible sobre VH y Onabotulinumtoxin A (OnabotA), mediante el debate de un panel de especialistas expertos. Material y métodosEncuesta realizada mediante el método Delphi a 42 panelistas con 93 ítems repartidos en 4 áreas estratégicas, que incluyen criterios y recomendaciones clínicas que pueden ayudar a mejorar en diferentes niveles el abordaje actual del paciente con VH. Se consideraron los avances recientes en la materia, las áreas de controversia y la valoración de sus posibilidades reales de aplicación a los distintos ámbitos asistenciales de nuestro sistema sanitario. ResultadosTodos los expertos consultados completaron las 2 tandas del cuestionario. En la primera se apreció un consenso de criterio en 64 de 93 (68,8%) cuestiones analizadas, y en la segunda ronda 83 (89,25%) de los ítems consultados, estableciéndose un acuerdo entre los panelistas respecto a: 1) definición, clasificación, detección y diagnóstico diferencial; 2) tratamiento médico; 3) tratamiento quirúrgico; y 4) papel de OnabotA en el tratamiento de la VH. ConclusionesEl consenso logrado se ajusta ampliamente a la más reciente evidencia científica en VH. Los panelistas consideran que puede plantearse una modificación en la definición actual de VH, y que parece necesario mejorar las herramientas de cribado. El tratamiento médico de la VH debe ser individualizado, escalonado y progresivo. OnabotA (Botox®) podría implicar ventajas con respecto a otros tratamientos, y se posiciona como una alternativa segura y eficaz para tratar la VH refractaria a fármacos." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Esteban M, Salinas J, Arlandis S, Díez J, Jiménez M, Rebassa M, et al. Consenso experto sobre la evidencia científica disponible acerca del uso de toxina botulínica en vejiga hiperactiva. Actas Urol Esp. 2014;38:209–216." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:4 [ "apendice" => "José María Adot Zurbano, Marta Allué, José Emilio Batista Miranda, Pedro Blasco, Salvador Bustamante Alarma, Joaquín Carela Espí, Argimiro Collado, Ángel Elizalde Amatria, Ángel Elizalde Benito, Gregorio Escribano, Susana de la Rosa, Jesús Fernández Rosáenz, Agustín Franco de Castro, Alejandro Galacho, María Justa García Matres, Juan Carlos Garmendia, Antonio Gómez Rodríguez, Fernando González-Chamorro, Raquel González López, Luis López Fando, Miguel Ángel López Aramburu, Antonio López García-Moreno, Blanca Madurga, Roberto Martínez, Esther Martínez Cuenca, Ignacio Otero Tejero, Francisco Palao Yago, José María Pena, Lluis Peri, Luis Prieto, José Miguel Puyol Payás, Carlos Rioja, Fernando Ramón de Fata, Enrique Robles, Antonio Rodríguez, Fernando Rodríguez Escovar, Luis Antonio Rodríguez Toves, Luis Rodríguez Villamil, Antonio Romero Hoyuela, Eduardo Vicente Palacio, Carmen Zubiaur, Sergio Zubillaga Guerrero." "etiqueta" => "Addendum 1" "titulo" => "Expert panel" "identificador" => "sec0040" ] 1 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix B" "titulo" => "Supplementary data" "identificador" => "sec0050" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1391 "Ancho" => 3094 "Tamanyo" => 258809 ] ] "descripcion" => array:1 [ "en" => "Development scheme for the modified Delphi method." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3580 "Ancho" => 3167 "Tamanyo" => 910957 ] ] "descripcion" => array:1 [ "en" => "Issues proposed to the expert panel on the role of botulinum toxin in the overactive bladder and the results from the 2nd round (disagreement, no consensus and agreement). To the right, the degree of consensus reached on the same issues is represented graphically." ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 34101 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:46 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The standardisation of terminology of lower urinary tract function: report for the standardisation sub-committee of the international continence society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Abrams" 1 => "L. Cardozo" 2 => "M. Fall" 3 => "D. Griffiths" 4 => "P. Rosier" 5 => "U. Ulmsten" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurourol Urodyn" "fecha" => "2002" "volumen" => "21" "paginaInicial" => "167" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11857671" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reviewing the ICS 2002 terminology report: the ongoing debate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Abrams" 1 => "W. Artibani" 2 => "L. Cardozo" 3 => "R. Dmochowski" 4 => "P. van Kerrebroeck" 5 => "P. Sand" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Neurourol Urodyn" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "293" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug treatment of overactive bladder: efficacy, cost and quality-of-life considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Hashim" 1 => "P. Abrams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Drugs" "fecha" => "2004" "volumen" => "64" "paginaInicial" => "1643" "paginaFinal" => "1656" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15257626" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de vejiga hiperactiva en España: estudio poblacional" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Castro-Díaz" 1 => "M. Espuña" 2 => "M. Prieto" 3 => "X. Badia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Esp Urol" "fecha" => "2005" "volumen" => "58" "paginaInicial" => "131" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15847270" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of overactive bladder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Milsom" 1 => "W. Stewart" 2 => "J. Thüroff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Manage Care" "fecha" => "2000" "volumen" => "IV" "numero" => "Suppl." "paginaInicial" => "S565" "paginaFinal" => "S573" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and burden of overactive bladder in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.F. Stewart" 1 => "J.B. van Rooyen" 2 => "G.W. Cundiff" 3 => "P. Abrams" 4 => "A.R. Herzog" 5 => "R. Corey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00345-002-0301-4" "Revista" => array:6 [ "tituloSerie" => "World J Urol" "fecha" => "2003" "volumen" => "20" "paginaInicial" => "327" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12811491" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health-related consequences of overactive bladder: an economic perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.W. Hu" 1 => "T.H. Wagner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2005.05654.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "43" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16086679" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La severidad de la vejiga hiperactiva modifica la carga asistencial y la productividad laboral" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Angulo" 1 => "F.J. Brenes" 2 => "D. Ochayta" 3 => "I. Lizarraga" 4 => "D. Arumi" 5 => "S. Trillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2013.11.002" "Revista" => array:3 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2013" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24210656" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Understanding the elements of overactive bladder: question raised by the EPIC study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.E. Irwin" 1 => "P. Abrams" 2 => "I. Milson" 3 => "Z. Kopp" 4 => "K. Reilly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2008.07573.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2008" "volumen" => "101" "paginaInicial" => "1381" "paginaFinal" => "1387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18336602" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence available on the use of the selective β3-adrenoceptor agonist mirabegron for the treatment of overactive bladder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.C. Angulo" 1 => "V. Khullar" 2 => "V.W. Nitti" 3 => "E. Siddiqui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2013.05.003" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "640" "paginaFinal" => "651" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23850394" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insight into new potential targets for the treatment of overactive bladder and detrusor overactivity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Cerruto" 1 => "A.D. Asimakopoulos" 2 => "W. Artibani" 3 => "G. del Popolo" 4 => "M. La Martina" 5 => "R. Carone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000339251" "Revista" => array:6 [ "tituloSerie" => "Urol Int" "fecha" => "2012" "volumen" => "89" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22738896" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Apostolidis" 1 => "P. Dasgupta" 2 => "C.J. Fowler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2005.12.010" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2006" "volumen" => "49" "paginaInicial" => "644" "paginaFinal" => "650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16426734" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuevo tratamiento para la vejiga hiperactiva. Experiencia inicial en el tratamiento de la vejiga hiperactiva refractaria con toxina botulínica tipo A" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Rebassa" 1 => "G. Conde" 2 => "M. Cholvi" 3 => "G. Briones" 4 => "A. Mus" 5 => "M. Blasco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Balear" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "28" "paginaFinal" => "33" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vejiga hiperactiva y su manejo con toxina botulínica tipo A en el Hospital General de México" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.J. Pérez" 1 => "M.A. Reyes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Mex Urol" "fecha" => "2010" "volumen" => "70" "paginaInicial" => "228" "paginaFinal" => "242" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The case for bladder botulinum toxin application" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.K. Kim" 1 => "C.A. Thomas" 2 => "C. Smith" 3 => "M.B. Chancellor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Urol Clin N Am" "fecha" => "2006" "volumen" => "33" "paginaInicial" => "503" "paginaFinal" => "510" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of urodynamic and detrusor contractility variables in patients with overactive bladder syndrome treated with botulinum toxin-A: is incomplete bladder emptying predictable?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Sahai" 1 => "P. Sangster" 2 => "V. Kalsi" 3 => "M.S. Khan" 4 => "C.J. Fowler" 5 => "P. Dasgupta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2008.08076.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2009" "volumen" => "103" "paginaInicial" => "630" "paginaFinal" => "634" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18990156" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity: clinical and urodynamic results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Giannantoni" 1 => "E. Mearini" 2 => "M. del Zingaro" 3 => "M. Porena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2008.08.048" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2009" "volumen" => "55" "paginaInicial" => "705" "paginaFinal" => "711" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18814955" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pelvic floor disorders network. Refractory idiopathic urge urinary incontinence and botulinum A injection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Brubaker" 1 => "H.E. Richter" 2 => "A. Visco" 3 => "S. Mahajan" 4 => "I. Nygaard" 5 => "T.M. Braun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2008.03.028" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2008" "volumen" => "180" "paginaInicial" => "217" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18499184" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on the treatment of overactive bladder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.R. Dmochowski" 1 => "A. Gomelsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOU.0b013e3283468da3" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Urol" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "286" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21499104" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phase 3 efficacy and tolerability study of onabotulinumtoxin A for urinary incontinence from neurogenic detrusor overactivity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Ginsberg" 1 => "A. Gousse" 2 => "V. Keppenne" 3 => "K.D. Sievert" 4 => "C. Thompson" 5 => "W. Lam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2012.01.125" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2012" "volumen" => "187" "paginaInicial" => "2131" "paginaFinal" => "2139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22503020" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of onabotulinumtoxin A in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Cruz" 1 => "S. Herschorn" 2 => "P. Aliotta" 3 => "M. Brin" 4 => "C. Thompson" 5 => "W. Lam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2011.07.002" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2011" "volumen" => "60" "paginaInicial" => "742" "paginaFinal" => "750" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21798658" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Onabotulinumtoxin A is effective in patients with urinary incontinence due to neurogenic detrusor activity regardless of concomitant anticholinergic use or neurologic etiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Ginsberg" 1 => "F. Cruz" 2 => "S. Herschorn" 3 => "A. Gousse" 4 => "V. Keppenne" 5 => "P. Aliotta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12325-013-0054-z" "Revista" => array:6 [ "tituloSerie" => "Adv Ther" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "819" "paginaFinal" => "833" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24072665" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Onabotulinumtoxin A for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.W. Nitti" 1 => "R. Dmochowski" 2 => "S. Herschorn" 3 => "P. Sand" 4 => "C. Thompson" 5 => "C. Nardo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2012.12.022" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2013" "volumen" => "189" "paginaInicial" => "2186" "paginaFinal" => "2193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23246476" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Onabotulinumtoxin A 100U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Chapple" 1 => "K.D. Sievert" 2 => "S. MacDiarmid" 3 => "V. Khullar" 4 => "P. Radziszewski" 5 => "C. Nardo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2013.04.001" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2013" "volumen" => "64" "paginaInicial" => "249" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23608668" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness of botulinum toxin A versus anticholinergic medications for idiopathic urge incontinence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. Wu" 1 => "N.Y. Siddiqui" 2 => "C.L. Amundsen" 3 => "E.R. Myers" 4 => "L.J. Havrilesky" 5 => "A.G. Visco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2009.01.037" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2009" "volumen" => "181" "paginaInicial" => "2181" "paginaFinal" => "2186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19296983" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pelvic floor disorders network. Anticholinergic versus botulinum toxin A comparison trial for the treatment of bothersome urge urinary incontinence: ABC trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.G. Visco" 1 => "L. Brubaker" 2 => "H.E. Richter" 3 => "I. Nygaard" 4 => "M.F. Paraiso" 5 => "S.A. Menefee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cct.2011.09.019" "Revista" => array:6 [ "tituloSerie" => "Contemp Clin Trials" "fecha" => "2012" "volumen" => "33" "paginaInicial" => "184" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22008247" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A modified Delphi method approach to a new card sorting methodology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Lyn Paul" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Usability Stud" "fecha" => "2008" "volumen" => "4" "paginaInicial" => "7" "paginaFinal" => "30" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Delphi method: an experimental study of group opinion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N.C. Dalkey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1969" "editorial" => "Rand Corporation" "editorialLocalizacion" => "Santa Monica (California)" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An exploration of the use of simple statistics to measure consensus and stability in Delphi studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.A. Holey" 1 => "J.L. Feeley" 2 => "J. Dixon" 3 => "V.J. Whittaker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2288-7-52" "Revista" => array:5 [ "tituloSerie" => "BMC Med Res Methodol" "fecha" => "2007" "volumen" => "7" "paginaInicial" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18045508" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptom-based diagnosis of overactive bladder: an overview" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Wein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5489/cuaj.11183" "Revista" => array:7 [ "tituloSerie" => "Can Urol Assoc J" "fecha" => "2011" "volumen" => "5" "numero" => "Suppl. 2" "paginaInicial" => "S135" "paginaFinal" => "S136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21989525" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urinary incontinence, overactive bladder, and other lower urinary tract symptoms: a longitudinal population-based survey in men aged 45–103 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "U.G. Malmsten" 1 => "U. Molander" 2 => "R. Peeker" 3 => "D.E. Irwin" 4 => "I. Milsom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2010.03.014" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2010" "volumen" => "58" "paginaInicial" => "149" "paginaFinal" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20356669" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treating overactive bladder in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Wagg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5489/cuaj.11188" "Revista" => array:7 [ "tituloSerie" => "Can Urol Assoc J" "fecha" => "2011" "volumen" => "5" "numero" => "Suppl. 2" "paginaInicial" => "S149" "paginaFinal" => "S151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21989530" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validación psicométrica de las escalas OAB-V8 y OAB-V3 para la detección de pacientes con probable vejiga hiperactiva en la población española" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Brenes" 1 => "J.C. Angulo" 2 => "D. Ochayta" 3 => "J. Rejas" 4 => "D. Arumí" 5 => "A. Cañadas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Clin" "fecha" => "2013" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of action of botulinum neurotoxins, β3-adrenergic receptor agonists, and PDE5 inhibitors in modulating detrusor function in overactive bladders: ICI-RS 2011" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Kanai" 1 => "I. Zabbarova" 2 => "M. Oefelein" 3 => "P. Radziszewski" 4 => "Y. Ikeda" 5 => "K.E. Andersson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/nau.21246" "Revista" => array:6 [ "tituloSerie" => "Neurourol Urodyn" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "300" "paginaFinal" => "308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22275187" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic benefit in patients switching tolterodine to other novel antimuscarinic agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Sánchez-Ballester" 1 => "P. Miranda" 2 => "I. Lizarraga" 3 => "J. Rejas" 4 => "D. Arumi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro" "Revista" => array:3 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2013" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24210656" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of refractory overactive bladder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Giarenis" 1 => "L. Cardozo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Ginecol" "fecha" => "2013" "volumen" => "65" "paginaInicial" => "41" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23412019" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.R. Chapple" 1 => "V. Khullar" 2 => "Z. Gabriel" 3 => "D. Muston" 4 => "C.E. Bitoun" 5 => "D. Weinstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2008.06.047" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2008" "volumen" => "54" "paginaInicial" => "543" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18599186" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and tolerability of mirabegron, a β(3)-adrenoceptor agonist, in patients with overactive bladder: results from a randomised European-Australian phase 3 trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Khullar" 1 => "G. Amarenco" 2 => "J.C. Angulo" 3 => "J. Cambronero" 4 => "K. Høye" 5 => "I. Milsom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2012.10.016" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2013" "volumen" => "63" "paginaInicial" => "283" "paginaFinal" => "295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23182126" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mirabegron for the treatment of overactive bladder: a prespecified pooled efficacy analysis and pooled safety analysis of three randomised, double-blind, placebo-controlled, phase iii studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.W. Nitti" 1 => "V. Khullar" 2 => "P. van Kerrebroeck" 3 => "S. Herschorn" 4 => "J. Cambronero" 5 => "J.C. Angulo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijcp.12194" "Revista" => array:6 [ "tituloSerie" => "Int J Clin Pract" "fecha" => "2013" "volumen" => "67" "paginaInicial" => "619" "paginaFinal" => "632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23692526" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Solifenacin plus tamsulosin combination treatment in men with lower urinary tract symptoms and bladder outlet obstruction: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.A. Kaplan" 1 => "W. He" 2 => "W.D. Koltun" 3 => "J. Cummings" 4 => "T. Schneider" 5 => "A. Fakhoury" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2012.07.003" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2013" "volumen" => "63" "paginaInicial" => "158" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22831853" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychometric validation of the Spanish version of the overactive bladder questionnaire short-form (OABQ-SF) to assess severity of symptoms and patient health related quality of life in subjects with overactive bladder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Arlandis-Guzmán" 1 => "M.A. Ruiz" 2 => "C. Errando-Smet" 3 => "F. Villacampa-Aubá" 4 => "M. García-Vargas" 5 => "D. Arumi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Value Health" "fecha" => "2010" "volumen" => "13" "paginaInicial" => "A479" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of botulinum toxin A intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Soljanik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40265-013-0068-5" "Revista" => array:6 [ "tituloSerie" => "Drugs" "fecha" => "2013" "volumen" => "73" "paginaInicial" => "1055" "paginaFinal" => "1066" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23775527" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An updated systematic review and statistical comparison of standardized mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Mangera" 1 => "A. Apostolidis" 2 => "K.E. Andersson" 3 => "P. Dasgupta" 4 => "A. Giannantoni" 5 => "C. Roehrborn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2013.10.033" "Revista" => array:2 [ "tituloSerie" => "Eur Urol" "fecha" => "2013" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The management of overactive bladder refractory to medical therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Robinson" 1 => "I. Giarenis" 2 => "L. Cardozo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.maturitas.2013.01.013" "Revista" => array:6 [ "tituloSerie" => "Maturitas" "fecha" => "2013" "volumen" => "75" "paginaInicial" => "101" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23415926" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pelvic floor electrostimulation in women with urinary incontinence and/or overactive bladder syndrome: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Jerez-Roig" 1 => "D.L. Souza" 2 => "A. Espelt" 3 => "M. Costa-Marín" 4 => "A.M. Belda-Molina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acuro.2012.08.003" "Revista" => array:6 [ "tituloSerie" => "Actas Urol Esp" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "429" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23246103" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sacral neuromodulation effects on periurethral sensation and urethral sphincter activity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Gleason" 1 => "K. Kenton" 2 => "W.J. Greer" 3 => "O. Ramm" 4 => "J.M. Szychowski" 5 => "T. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/nau.22319" "Revista" => array:6 [ "tituloSerie" => "Neurourol Urodyn" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "476" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23168535" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003800000004/v1_201405090042/S2173578614000262/v1_201405090042/en/main.assets" "Apartado" => array:4 [ "identificador" => "6273" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003800000004/v1_201405090042/S2173578614000262/v1_201405090042/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000262?idApp=UINPBA00004N"]

Statistics

Special article

Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder

Consenso experto sobre la evidencia científica disponible acerca del uso de toxina botulínica en vejiga hiperactiva

M. Estebana,

Corresponding author

ESTEBOTE@telefonica.net

Corresponding author.

, J. Salinasb, S. Arlandisc, J. Díezd, M. Jiméneze, M. Rebassaf, J.C. Angulog

a Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, Spain

b Servicio de Urología, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain

c Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain

d Servicio de Urología, Hospital Universitario Infanta Sofía, Madrid, Spain

e Servicio de Urología, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain

f Servicio de Urología, Hospital Son Llàtzer, Palma de Mallorca, Spain

g Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain

Read

451

Times
was read the article

138

Total PDF

313

Total HTML

Share statistics

 array:23 [
  "pii" => "S2173578614000262"
  "issn" => "21735786"
  "doi" => "10.1016/j.acuroe.2014.02.010"
  "estado" => "S300"
  "fechaPublicacion" => "2014-05-01"
  "aid" => "611"
  "copyright" => "AEU"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Actas Urol Esp. 2014;38:209-16"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 454
    "formatos" => array:3 [
      "EPUB" => 7
      "HTML" => 311
      "PDF" => 136
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210480613004191"
      "issn" => "02104806"
      "doi" => "10.1016/j.acuro.2013.12.002"
      "estado" => "S300"
      "fechaPublicacion" => "2014-05-01"
      "aid" => "611"
      "copyright" => "AEU"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "Actas Urol Esp. 2014;38:209-16"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 781
        "formatos" => array:3 [
          "EPUB" => 8
          "HTML" => 533
          "PDF" => 240
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo especial</span>"
        "titulo" => "Consenso experto sobre la evidencia cient&#237;fica disponible acerca del uso de toxina botul&#237;nica en vejiga hiperactiva"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "209"
            "paginaFinal" => "216"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1391
                "Ancho" => 3094
                "Tamanyo" => 268115
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Esquema del desarrollo del m&#233;todo Delphi modificado&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Esteban, J&#46; Salinas, S&#46; Arlandis, J&#46; D&#237;ez, M&#46; Jim&#233;nez, M&#46; Rebassa, J&#46;C&#46; Angulo"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Esteban"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Salinas"
              ]
              2 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Arlandis"
              ]
              3 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "D&#237;ez"
              ]
              4 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Jim&#233;nez"
              ]
              5 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Rebassa"
              ]
              6 => array:2 [
                "nombre" => "J&#46;C&#46;"
                "apellidos" => "Angulo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173578614000262"
          "doi" => "10.1016/j.acuroe.2014.02.010"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000262?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480613004191?idApp=UINPBA00004N"
      "url" => "/02104806/0000003800000004/v1_201404250112/S0210480613004191/v1_201404250112/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173578614000213"
    "issn" => "21735786"
    "doi" => "10.1016/j.acuroe.2014.02.005"
    "estado" => "S300"
    "fechaPublicacion" => "2014-05-01"
    "aid" => "583"
    "copyright" => "AEU"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Urol Esp. 2014;38:217-23"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 594
      "formatos" => array:3 [
        "EPUB" => 9
        "HTML" => 476
        "PDF" => 109
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Optimizing prostate cancer screening&#59; prospective randomized controlled study of the role of PSA and PCA3 testing in a sequential manner in an opportunistic screening program"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "217"
          "paginaFinal" => "223"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Optimizaci&#243;n de un programa de cribado oportunista de c&#225;ncer de pr&#243;stata&#59; ensayo aleatorizado prospectivo del papel del PSA y del PCA3 en uso secuencial"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2656
              "Ancho" => 2570
              "Tamanyo" => 396259
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Results of the study&#46; <span class="elsevierStyleItalic">Abbreviations</span>&#58; Gl&#46; Gleason score&#59; IBx&#44; initial biopsy&#59; PSA&#44; prostate-specific antigen&#59; RE&#44; rectal examination&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Rubio-Briones, J&#46; Casanova, R&#46; Dumont, L&#46; Rubio, A&#46; Fernandez-Serra, I&#46; Casanova-Salas, J&#46; Dom&#237;nguez-Escrig, M&#46; Ram&#237;rez-Backhaus, A&#46; Collado, A&#46; G&#243;mez-Ferrer, I&#46; Iborra, J&#46;L&#46; Monr&#243;s, J&#46;V&#46; Ric&#243;s, E&#46; Solsona, D&#46; Salas, F&#46; Mart&#237;nez, J&#46;A&#46; Lopez-Guerrero"
          "autores" => array:17 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Rubio-Briones"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Casanova"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Dumont"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Rubio"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Fernandez-Serra"
            ]
            5 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Casanova-Salas"
            ]
            6 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Dom&#237;nguez-Escrig"
            ]
            7 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Ram&#237;rez-Backhaus"
            ]
            8 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Collado"
            ]
            9 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "G&#243;mez-Ferrer"
            ]
            10 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Iborra"
            ]
            11 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "Monr&#243;s"
            ]
            12 => array:2 [
              "nombre" => "J&#46;V&#46;"
              "apellidos" => "Ric&#243;s"
            ]
            13 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Solsona"
            ]
            14 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Salas"
            ]
            15 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Mart&#237;nez"
            ]
            16 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Lopez-Guerrero"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210480613003331"
        "doi" => "10.1016/j.acuro.2013.09.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480613003331?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000213?idApp=UINPBA00004N"
    "url" => "/21735786/0000003800000004/v1_201405090042/S2173578614000213/v1_201405090042/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
    "titulo" => "Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "209"
        "paginaFinal" => "216"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Esteban, J&#46; Salinas, S&#46; Arlandis, J&#46; D&#237;ez, M&#46; Jim&#233;nez, M&#46; Rebassa, J&#46;C&#46; Angulo"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Esteban"
            "email" => array:1 [
              0 => "ESTEBOTE&#64;telefonica&#46;net"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Salinas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Arlandis"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "D&#237;ez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Jim&#233;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Rebassa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "J&#46;C&#46;"
            "apellidos" => "Angulo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:7 [
          0 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Nacional de Parapl&#233;jicos&#44; Toledo&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Cl&#237;nico San Carlos&#44; Universidad Complutense&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario Infanta Sof&#237;a&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Ram&#243;n y Cajal&#44; Universidad de Alcal&#225; de Henares&#44; Madrid&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Son Ll&#224;tzer&#44; Palma de Mallorca&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Urolog&#237;a&#44; Hospital Universitario de Getafe&#44; Universidad Europea de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Consenso experto sobre la evidencia cient&#237;fica disponible acerca del uso de toxina botul&#237;nica en vejiga hiperactiva"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 3580
            "Ancho" => 3167
            "Tamanyo" => 910957
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Issues proposed to the expert panel on the role of botulinum toxin in the overactive bladder and the results from the 2nd round &#40;disagreement&#44; no consensus and agreement&#41;&#46; To the right&#44; the degree of consensus reached on the same issues is represented graphically&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Overactive bladder &#40;OAB&#41; has been defined since 2002 as the onset of urinary urgency&#44; with or without urge incontinence&#44; which can be accompanied by frequent urination and&#47;or nocturia&#44; provided other concomitant urinary tract diseases such as infection or lithiasis have been ruled out&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Its etiology is unknown but could be multifactorial and include nervous system &#40;central and peripheral&#41; or bladder muscle abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> OAB has a high prevalence that increases with age&#46; In Spain&#44; OAB affects approximately 21&#46;5&#37; of the population over 40 years of age and approximately 30&#37; of individuals older than 75 years&#44; affecting men and women similarly&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> European and American epidemiological studies have revealed a similar epidemiology&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Hu et al&#46; estimated the financial cost of OAB in the US at more than 9 billion dollars annually&#44; with more than 1 billion for the treatment of associated urinary infections&#46; This does not take into account the costs due to loss of productivity and unquantifiable losses&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The negative impact is also apparent in the patients&#8217; quality of life due to the shame&#44; frustration&#44; anxiety&#44; depression&#44; sexual dysfunction&#44; physical-psychological impairment&#44; insomnia and urinary tract and skin infections resulting from OAB&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Fifty-three percent of patients with OAB report that their symptoms are truly bothersome&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Treatment for OAB is usually based on dietary changes&#44; fluid restriction&#44; bladder training&#44; pelvic physical therapy&#44; biofeedback&#44; electrical stimulation and drug therapy &#40;anticholinergic agents as first-line treatment and beta-adrenergic agonists&#41;&#46; Anticholinergic drugs often have adverse effects &#40;dry mouth&#44; blurred vision and cognitive changes&#41;&#44; which do not occur with beta agonists&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and the extended use of anticholinergic drugs decreases their efficacy&#46; Other vanilloid drugs &#40;capsaicin and resinferatoxin&#41; are under development&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Onabotulinum toxin A &#40;OnabotA&#41; has proven to be a therapeutic alternative in patients with refractory OAB&#44; due to its ability to reversibly block motor and sensory nerve transmission by inhibiting the release of acetylcholine &#40;efferent&#41; and other neurotransmitters that participate in afferent signaling&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This mechanism of action could explain the motor effect in the relaxation of the detrusor muscle and its sensory effect&#44; such as the feeling of urgency&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In fact&#44; the intravesical injection of OnabotA is increasingly used as an intervention for refractory OAB&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;19</span></a> The efficacy and safety of OnabotA has been demonstrated in 4 phase 3 trials&#44; in the treatment of both neurogenic<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> and idiopathic OAB&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> The optimal dose in the treatment of neurogenic OAB is 200<span class="elsevierStyleHsp" style=""></span>U&#44; which reduces the number of incontinence episodes in week 6 of the therapy by 100&#37; in 37&#37; of patients and by 50&#37; in 76&#37; of the patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> The optimal recommended dose in the treatment of idiopathic OAB is 100<span class="elsevierStyleHsp" style=""></span>U&#46; In this case&#44; the treatment reduced the number of incontinence episodes by 100&#37; in 27&#46;1&#37; and by 50&#37; in 60&#46;5&#37; of the patients included in the studies&#46; The patients tolerated the treatment well&#59; the most common adverse effects were urinary tract infection and urinary retention&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;24</span></a> Patients also showed significant improvements in quality of life according to standard scales&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;24</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A cost-effectiveness study showed that OnabotA is more cost-efficient when compared with anticholinergic treatment over a 2-year period&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Due to the cost and loss of efficacy of anticholinergic agents&#44; the use of toxins has been proposed for first or second-line treatment in women with urinary incontinence&#46; The double-blind&#44; randomized ABC trial compared the efficacy of 100<span class="elsevierStyleHsp" style=""></span>U of toxin versus anticholinergic agents in women treated for 6 months for moderate to serious urinary incontinence&#46; The results of the trial favored OnabotA&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although not accompanied by high levels of recommendation&#44; expert consensus meetings are useful for clarifying new available evidence and facilitating the clinical management of patients in special conditions&#44; as happens with the need for employing botulinum toxin in patients with OAB that is refractory to other treatments&#46; These types of activities favor conceptual homogenization and decision making and attempt to unify the diagnostic and therapeutic criteria used in clinical practice&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">For the implementation of the study&#44; we used the Delphi method modified by Lyn Paul&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Under the direction of a scientific committee&#44; the study was performed in 4 phases&#46; In the first phase&#44; the committee proceeded with a structured review of the most recently published quality literature &#40;in English and Spanish&#41; on OAB in order to select the contents of questionnaires&#46; A national panel of 43 experts was then selected and formed by urologists from various autonomous communities&#44; with special interest and experience in functional bladder disorders and OAB syndrome &#40;Appendix 1&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the second phase&#44; the items for the survey were developed &#40;professional criteria and clinical recommendations subjected to debate&#41;&#44; using a previously employed&#44; in-person&#44; qualitative work procedure by the experts&#46; The final version of the questionnaire included 93 items &#40;see additional material attached&#41;&#44; distributed in subject blocks as follows&#58; 24 items on &#8220;the definition&#44; classification&#44; detection and differential diagnosis of OAB&#8221;&#44; 27 items on &#8220;the medical treatment of OAB&#8221;&#44; 20 items on &#8220;the surgical treatment of OAB&#8221; and 22 items on &#8220;the role of OnabotA in OAB&#8221;&#46; The project&#39;s fieldwork was conducted between September 2012 and October 2012&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The third phase &#40;which was not in person but was performed by an independent technical team&#41; consisted of the application of a modified Delphi method that requested the individual expert&#39;s anonymous opinion on the issue at hand through the completion of a structured written survey &#40;sent by e-mail&#41;&#44; in an anonymous and confidential manner&#46; After this phase&#44; there was a second round of surveys on the issues that failed to achieve consensus in the first round&#44; providing the participants with the results obtained by the group in the first questionnaire&#44; as well as the comments explaining their opinions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A single type of rating scale was proposed for all issues&#46; The scale was a 9-point ordinal Likert scale &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>strongly disagree&#59; 9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>strongly agree&#41;&#44; based on the format developed by UCLA-Rand Corporation for the assessment method for the appropriate use of health technology&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> The response categories are described by means of language qualifiers in 3 regions &#40;1&#8211;3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#8220;</span>disagree&#8221;&#59; 4&#8211;6<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#8220;</span>neither agree nor disagree&#8221;&#59; 7&#8211;9<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8220;agree&#8221;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The fourth phase corresponds to the collection and analysis of results&#46; We used the median scores of the group and the level of correlation reached by the surveys&#44; according to the following criterion&#58; an item is considered agreed upon when there is an &#8220;agreement&#8221; of opinion on the panel&#44; i&#46;e&#46;&#44; when the number of experts who score outside the 3-point region that contains the median &#40;&#91;1&#8211;3&#93;&#44; &#91;4&#8211;6&#93;&#44; &#91;7&#8211;9&#93;&#41; is less than a third of those surveyed&#46; In such cases&#44; the median value determines the group consensus&#58; The majority &#8220;disagree&#8221; with the item&#44; if the median is &#8804;3&#44; or the majority &#8220;agree&#8221; with the item if the median is &#8805;7&#46; Items for which the median was in the 4&#8211;6 region were considered &#8220;questionable&#8221;&#46; Conversely&#44; a &#8220;disagreement&#8221; of opinion was determined to exist in the panel when the scores of a third or more of the panelists were in the 1&#8211;3 region and another third or more in the 7&#8211;9 region&#46; The remaining items on which there was no agreement or disagreement were considered to have an &#8220;indeterminate&#8221; level of consensus&#46; All items on which the group did not reach a clear consensus in favor or against the issue raised &#40;questionable items&#44; those in which disagreement was observed and those with an indeterminate level of consensus&#41; were proposed for reconsideration by the panel in the second Delphi around&#46; Items with a high distribution of opinions among those surveyed&#44; with an IQR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>4 points &#40;scores within the Q1 and Q3 values of the distribution&#41;&#44; were also submitted for reevaluation&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The Delphi method provides several advantages including anonymity&#44; which avoids the &#8220;effect of authority&#8221; related to the evidence generated by the opinion of experts&#46; On the other hand&#44; its potential drawbacks include the difficulties in properly selecting professional experts on the subject and the difficulties in preparing the questionnaire for reaching a consensus&#46; These drawbacks are solved by the selection of representative panelists of recognized prestige and with the proper preparation of an appropriate questionnaire by an objective scientific committee&#46; The bias associated with this type of study is thereby reduced&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The 42 experts completed 2 rounds of evaluation&#46; Sufficient consensus was reached on 83 of the 93 items &#40;89&#46;25&#37;&#41;&#44; 78 &#40;94&#37;&#41; agreed upon in terms of agreement with the statement&#44; and the 5 remaining &#40;6&#37;&#41; agreed upon in terms of rejection&#46; In the first round&#44; consensus was established for 64 of the 93 items&#46; For the remaining 29 items proposed for reconsideration by the experts in the second round&#44; consensus was achieved for 19 of the items&#46; Ten of the items&#44; however&#44; did not achieve consensus&#44; representing 10&#46;75&#37; of the opportunities for agreement in the overall series of statements and 34&#46;5&#37; of the opportunities for agreement in the second around&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The supplementary material lists the overall results of the project&#44; indicating for each item the centering statistic &#40;median&#41;&#44; the distribution rate for those surveyed who are located outside the region chosen by the majority and the interquartile range&#46; The addendum also identifies whether the item was accepted or rejected by the panel to facilitate the reading of each item in the tables&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Of the agreed-upon items&#44; 9 achieved a median score of 9&#46; Four of these issues corresponded to the definition&#44; classification&#44; detection and diagnosis block &#40;questions 8&#44; 13&#44; 17 and 18&#41;&#46; These items refer to the multifactorial etiology of OAB in the elderly&#44; the urologist&#39;s role as responsible specialist for referrals of complex cases or for patients who respond poorly to initial treatment&#44; as well as the role of the urodynamic study in patients with neurogenic bladder dysfunction&#44; in OAB that does not response to treatment and in complex UI&#46; Only one item corresponded to the medical treatment block &#40;question 26&#41;&#44; which concerns the 2 well-differentiated treatment levels for OAB&#58; the initial &#40;conservative treatment&#44; antimuscarinic agents&#41; and the specialized &#40;neuromodulation&#44; OnabotA&#44; surgery&#44; stimulation of the posterior tibial nerve&#41;&#46; Another 2 items focused on the surgical treatment block &#40;questions 52 and 71&#41;&#44; specifying that an assessment of symptom intensity and their impact on quality of life should be conducted before second-line treatment is started and that surgery is clearly justified when OAB is due to an obstructive prolapse&#46; The last 2 items focus on OnabotA &#40;questions 72 and 83&#41;&#44; highlighting that this treatment is an effective and safe alternative in OAB refractory to anticholinergic agents and that a urine sediment and culture test should be conducted for all cases before starting this treatment &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The items that&#44; in addition to achieving a median score of 9&#44; had no panelist in disagreement were questions 8&#44; 26&#44; 52 and 72&#46; Three of these focused on second-line treatment and the issues related to the use of OnabotA&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Of all the content agreed upon in the questionnaire&#44; 5 were expressly rejected by group consensus&#44; 4 in the definition and diagnostic chapter and 1 in the medical treatment chapter&#46; These items dealt with considerations such as &#8220;OAB has a proper definition for care&#8221;&#44; &#8220;OAB screening tools are not needed&#8221;&#44; &#8220;the frequency&#47;volume sheet&#44; the voiding diary and&#47;or the urgency scale are dispensable&#8221; and &#8220;lifestyle change recommendations have low efficacy&#8221;&#46; None of the statements or items regarding surgical treatment or use of OnabotA were rejected&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Among the 10 proposals not agreed upon&#44; 3 had majority but insufficient support from those surveyed&#46; These were &#8220;detrusor hyperactivity does not determine better or worse response to treatment&#8221; &#40;34&#46;1&#37; disagree&#41;&#44; &#8220;onabotulinum toxin A can reverse refractoriness to antimuscarinic agents&#8221; &#40;30&#46;7&#37; disagree&#41; and &#8220;if the effect of onabotulinum toxin A decreases&#44; its endovesical instillation may be considered&#8221; &#40;only 12&#46;5&#37; disagree&#41;&#46; The disagreement in expert opinion was also made clear by the fact that more than 35&#37; of the panelists disagreed with the items concerning &#8220;the indication for pelvic floor muscle exercises&#8221;&#44; &#8220;the low efficacy of antimuscarinic agents&#8221;&#44; &#8220;the inappropriate handling of antimuscarinic agents in consultations&#8221;&#44; &#8220;the lack of evidence in peripheral electrical stimulation&#8221;&#44; &#8220;the scarcity of reference centers for neuromodulation can result in the undertreatment of refractory OAB&#8221;&#44; &#8220;the list of essential and recommended tests before injecting toxins&#8221; or &#8220;whether repeated injections of toxin affects postvoid residual urine&#8221;&#46; All of these issues reveal the disparity of professional opinion or a lack of criteria for the majority&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The Delphi methodology is widely used in biomedicine and helps achieve professional consensus in a group of geographically dispersed experts&#46; Successive rounds with processing and dissemination of interim result help achieve professional consensus&#44; which results in the establishment of important recommendations aimed at decreasing variability in standard clinical practice&#46; We have gathered relevant information about the main clinical controversies concerning the management of OAB and the indications and use of OnabotA&#46; Specialists in this disease achieve a high degree of consensus on most issues and help establish the clinical positioning of this drug in the treatment of OAB&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The panelists generally rejected the current definition of OAB due to its ambiguity&#44; multiple origins and to the fact that it precludes potential organic diseases&#44; thereby encouraging diagnoses that are often inaccurate&#44; sometimes wrong and that lead to overtreatment&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There is a consensus to include other aspects in the definition of OAB to avoid errors and to consider a third category of OAB secondary to other diseases&#46; There is also consensus in terms of the prevalence&#44; symptoms and epidemiology of OAB&#44; which is consistent with internationally published data&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#8211;32</span></a> The panelists also considered necessary the use of diagnostic screening tools and increased training in the disease&#44; especially in primary care&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In terms of the clinical&#44; diagnostic&#44; therapeutic and prognostic differences associated with detrusor hyperactivity&#44; it has been demonstrated that various treatments for OAB &#40;pharmacological&#44; neuromodulation and OnabotA&#41; have an inhibitory effect not only on detrusor contractility &#40;motor or efferent&#41;&#44; but also on the afferent or sensory element &#40;<span class="elsevierStyleSmallCaps">C</span> fibers&#41;&#46; Thus&#44; the lack of an increase in the motor phenomenon such as detrusor hyperactivity would not preclude treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Based on the judgment of most panelists&#44; the medical treatment of OAB must be individualized&#44; phased and progressive due to its multiple etiology &#40;neurogenic&#44; muscle or other&#41;&#44; severity and potential pharmacological contraindications&#46; Treatment should start with conservative therapy&#44; which should include pelvic floor muscle training for women&#46; In terms of drug treatment based on antimuscarinic agents&#44; the panelists reported low compliance and disagreement regarding the efficacy and clinical management&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> The associated causes were treatment intolerance&#44; reported adverse events and the loss of efficacy after extended treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;14&#44;36</span></a> There are indeed significant variations in antimuscarinic treatment for patients with OAB&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> Additionally&#44; other issues such as the role of beta-adrenergic agonists &#40;mirabegron&#41;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;39</span></a> and even its possible combination with antimuscarinic agents&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> the night-time dosage of antimuscarinic agents and the combination with other drugs<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> also result in a lack of consensus on the results&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In terms of the surgical treatment of OAB&#44; there was broad consensus on the need to measure symptoms intensity and their repercussion on quality of life before starting second-line treatments&#46; The OABQ-SF scale is probably the best questionnaire for assessment and follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> For the treatment of refractory OAB&#44; the use of OnabotA and sacral neuromodulation has been endorsed by various publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#8211;44</span></a> Other techniques such as peripheral electrical stimulation &#40;intravaginal or endoanal&#41; and neuromodulation using TENS or SANS &#40;posterior tibia&#41; are simple and economic procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> Sacral neuromodulation is more complex and has a high financial cost&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The use of OnabotA in the treatment of OAB refractory to drugs stands as an effective and safe alternative&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;43</span></a> The approved dosage for neurogenic and idiopathic OAB is 200<span class="elsevierStyleHsp" style=""></span>U and 100<span class="elsevierStyleHsp" style=""></span>U&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;19&#44;43</span></a> Another characteristic worth highlighting is its simple administration&#44; which represents a significant advantage over sacral neuromodulation&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> OnabotA is also a cost-effective short to medium-term treatment when compared to drug treatment&#46; Long-term OnabotA treatment is similar&#44; and even superior&#44; to sacral neuromodulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The consensus achieved by a group of specialists closely matches the most recent scientific evidence on OAB&#46; The panelists considered that a change in the current definition of OAB could be contemplated&#44; due to its ambiguity and to its exclusion of other possible causes&#46; The panelists also emphasized the need for improving screening tools&#46; Finally&#44; it is worth noting that medical treatment of OAB should be individualized&#44; phased and progressive in relation to the various etiologies&#46; Botulinum toxin A &#40;Botox<span class="elsevierStyleSup">&#174;</span>&#41; could have advantages when compared with other treatments and is a safe and effective alternative for treating OAB refractory to drugs&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">Allegan S&#46;A&#46; provided support to the scientific committee and funded the study and tasks related to the Delphi survey&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">Spanish Urological Association sponsored the present project&#44; in collaboration with Allergan S&#46;A&#46; Allergan S&#46;A&#46; has not participated in the design&#44; data analysis or drafting of the present article&#46; Luz&#225;n5 performed administrative support necessary for the implementation of this study&#44; including the design&#44; data collection and analysis&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:2 [
          "identificador" => "xres337394"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Objectives"
            2 => "Material and methods"
            3 => "Results"
            4 => "Conclusions"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec318942"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres337395"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Objetivos"
            2 => "Material y m&#233;todos"
            3 => "Resultados"
            4 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec318941"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-12-11"
    "fechaAceptado" => "2013-12-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec318942"
          "palabras" => array:5 [
            0 => "Overactive bladder"
            1 => "Diagnosis"
            2 => "Treatment"
            3 => "Onabotulinumtoxin A"
            4 => "Delphi method"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec318941"
          "palabras" => array:5 [
            0 => "Vejiga hiperactiva"
            1 => "Diagn&#243;stico"
            2 => "Tratamiento"
            3 => "Onabotulinumtoxin A"
            4 => "M&#233;todo Delphi"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Overactive bladder &#40;OAB&#41; is a pathology impairing patients&#8217; quality of life and with a high percentage of patients who are refractory to medication&#46; In this paper&#44; technical opinion of an &#171;expert panel&#187; is assessed in order to gain the most reliable professional consensus on scientific evidence available on the criteria for the use of Onabotulinumtoxin A &#40;OnabotA&#41; in OAB&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">According to DELPHI method&#44; 42 panelists answered a survey of 93 items divided into four strategic areas including clinical criteria and recommendations in order to improve&#44; at different levels&#44; the current approach to patients with OAB&#46; The recent advances in the field&#44; areas of controversy and their real application possibilities in the different areas of our health care system were taken into consideration&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Two rounds of the questionnaire were completed by all experts&#46; In the first round&#44; a criteria consensus was reached for 64 of 93 &#40;68&#46;8&#37;&#41; questions analyzed&#59; in the second round the consensus reached was for 83 items evaluated &#40;89&#46;25&#37;&#41;&#46; An agreement among panelists was reached for&#58; &#40;1&#41; definition&#44; classification&#44; detection and differential diagnosis&#59; &#40;2&#41; medical treatment&#59; &#40;3&#41; surgical treatment&#59; and &#40;4&#41; role of OnabotA in the treatment of OAB&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The consensus is broadly in line with the latest scientific evidence on OAB&#46; The panelists believe that it is necessary to propose a change in the current definition of OAB and that it seems necessary to improve the screening tools too&#46; Medical treatment of OAB must be tailored to each patient&#44; staged and progressive&#46; The use of OnabotA &#40;Botox<span class="elsevierStyleSup">&#174;</span>&#41; could imply therapeutic advantages with respect to other treatments&#44; and positions itself as a safe and effective alternative to treat drug refractory OAB&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La vejiga hiperactiva &#40;VH&#41; es una enfermedad que afecta negativamente la calidad de vida y con un porcentaje elevado de pacientes refractarios a la medicaci&#243;n&#46; Se pretende explorar la opini&#243;n t&#233;cnica de un panel experto y alcanzar consenso en el criterio profesional en relaci&#243;n con la evidencia cient&#237;fica disponible sobre VH y Onabotulinumtoxin A &#40;OnabotA&#41;&#44; mediante el debate de un panel de especialistas expertos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Encuesta realizada mediante el m&#233;todo Delphi a 42 panelistas con 93 &#237;tems repartidos en 4 &#225;reas estrat&#233;gicas&#44; que incluyen criterios y recomendaciones cl&#237;nicas que pueden ayudar a mejorar en diferentes niveles el abordaje actual del paciente con VH&#46; Se consideraron los avances recientes en la materia&#44; las &#225;reas de controversia y la valoraci&#243;n de sus posibilidades reales de aplicaci&#243;n a los distintos &#225;mbitos asistenciales de nuestro sistema sanitario&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Todos los expertos consultados completaron las 2 tandas del cuestionario&#46; En la primera se apreci&#243; un consenso de criterio en 64 de 93 &#40;68&#44;8&#37;&#41; cuestiones analizadas&#44; y en la segunda ronda 83 &#40;89&#44;25&#37;&#41; de los &#237;tems consultados&#44; estableci&#233;ndose un acuerdo entre los panelistas respecto a&#58; 1&#41; definici&#243;n&#44; clasificaci&#243;n&#44; detecci&#243;n y diagn&#243;stico diferencial&#59; 2&#41; tratamiento m&#233;dico&#59; 3&#41; tratamiento quir&#250;rgico&#59; y 4&#41; papel de OnabotA en el tratamiento de la VH&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El consenso logrado se ajusta ampliamente a la m&#225;s reciente evidencia cient&#237;fica en VH&#46; Los panelistas consideran que puede plantearse una modificaci&#243;n en la definici&#243;n actual de VH&#44; y que parece necesario mejorar las herramientas de cribado&#46; El tratamiento m&#233;dico de la VH debe ser individualizado&#44; escalonado y progresivo&#46; OnabotA &#40;Botox&#174;&#41; podr&#237;a implicar ventajas con respecto a otros tratamientos&#44; y se posiciona como una alternativa segura y eficaz para tratar la VH refractaria a f&#225;rmacos&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Esteban M&#44; Salinas J&#44; Arlandis S&#44; D&#237;ez J&#44; Jim&#233;nez M&#44; Rebassa M&#44; et al&#46; Consenso experto sobre la evidencia cient&#237;fica disponible acerca del uso de toxina botul&#237;nica en vejiga hiperactiva&#46; Actas Urol Esp&#46; 2014&#59;38&#58;209&#8211;216&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:2 [
          0 => array:4 [
            "apendice" => "<p id="par0130" class="elsevierStylePara elsevierViewall">Jos&#233; Mar&#237;a Adot Zurbano&#44; Marta Allu&#233;&#44; Jos&#233; Emilio Batista Miranda&#44; Pedro Blasco&#44; Salvador Bustamante Alarma&#44; Joaqu&#237;n Carela Esp&#237;&#44; Argimiro Collado&#44; &#193;ngel Elizalde Amatria&#44; &#193;ngel Elizalde Benito&#44; Gregorio Escribano&#44; Susana de la Rosa&#44; Jes&#250;s Fern&#225;ndez Ros&#225;enz&#44; Agust&#237;n Franco de Castro&#44; Alejandro Galacho&#44; Mar&#237;a Justa Garc&#237;a Matres&#44; Juan Carlos Garmendia&#44; Antonio G&#243;mez Rodr&#237;guez&#44; Fernando Gonz&#225;lez-Chamorro&#44; Raquel Gonz&#225;lez L&#243;pez&#44; Luis L&#243;pez Fando&#44; Miguel &#193;ngel L&#243;pez Aramburu&#44; Antonio L&#243;pez Garc&#237;a-Moreno&#44; Blanca Madurga&#44; Roberto Mart&#237;nez&#44; Esther Mart&#237;nez Cuenca&#44; Ignacio Otero Tejero&#44; Francisco Palao Yago&#44; Jos&#233; Mar&#237;a Pena&#44; Lluis Peri&#44; Luis Prieto&#44; Jos&#233; Miguel Puyol Pay&#225;s&#44; Carlos Rioja&#44; Fernando Ram&#243;n de Fata&#44; Enrique Robles&#44; Antonio Rodr&#237;guez&#44; Fernando Rodr&#237;guez Escovar&#44; Luis Antonio Rodr&#237;guez Toves&#44; Luis Rodr&#237;guez Villamil&#44; Antonio Romero Hoyuela&#44; Eduardo Vicente Palacio&#44; Carmen Zubiaur&#44; Sergio Zubillaga Guerrero&#46;</p>"
            "etiqueta" => "Addendum 1"
            "titulo" => "Expert panel"
            "identificador" => "sec0040"
          ]
          1 => array:4 [
            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix B"
            "titulo" => "Supplementary data"
            "identificador" => "sec0050"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1391
            "Ancho" => 3094
            "Tamanyo" => 258809
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Development scheme for the modified Delphi method&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 3580
            "Ancho" => 3167
            "Tamanyo" => 910957
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Issues proposed to the expert panel on the role of botulinum toxin in the overactive bladder and the results from the 2nd round &#40;disagreement&#44; no consensus and agreement&#41;&#46; To the right&#44; the degree of consensus reached on the same issues is represented graphically&#46;</p>"
        ]
      ]
      2 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.docx"
          "ficheroTamanyo" => 34101
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:46 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The standardisation of terminology of lower urinary tract function&#58; report for the standardisation sub-committee of the international continence society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Abrams"
                            1 => "L&#46; Cardozo"
                            2 => "M&#46; Fall"
                            3 => "D&#46; Griffiths"
                            4 => "P&#46; Rosier"
                            5 => "U&#46; Ulmsten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurourol Urodyn"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "paginaInicial" => "167"
                        "paginaFinal" => "178"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11857671"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reviewing the ICS 2002 terminology report&#58; the ongoing debate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Abrams"
                            1 => "W&#46; Artibani"
                            2 => "L&#46; Cardozo"
                            3 => "R&#46; Dmochowski"
                            4 => "P&#46; van Kerrebroeck"
                            5 => "P&#46; Sand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Neurourol Urodyn"
                        "fecha" => "2009"
                        "volumen" => "28"
                        "paginaInicial" => "293"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Drug treatment of overactive bladder&#58; efficacy&#44; cost and quality-of-life considerations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Hashim"
                            1 => "P&#46; Abrams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs"
                        "fecha" => "2004"
                        "volumen" => "64"
                        "paginaInicial" => "1643"
                        "paginaFinal" => "1656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15257626"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de vejiga hiperactiva en Espa&#241;a&#58; estudio poblacional"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Castro-D&#237;az"
                            1 => "M&#46; Espu&#241;a"
                            2 => "M&#46; Prieto"
                            3 => "X&#46; Badia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Esp Urol"
                        "fecha" => "2005"
                        "volumen" => "58"
                        "paginaInicial" => "131"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15847270"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of overactive bladder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Milsom"
                            1 => "W&#46; Stewart"
                            2 => "J&#46; Th&#252;roff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Manage Care"
                        "fecha" => "2000"
                        "volumen" => "IV"
                        "numero" => "Suppl&#46;"
                        "paginaInicial" => "S565"
                        "paginaFinal" => "S573"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and burden of overactive bladder in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;F&#46; Stewart"
                            1 => "J&#46;B&#46; van Rooyen"
                            2 => "G&#46;W&#46; Cundiff"
                            3 => "P&#46; Abrams"
                            4 => "A&#46;R&#46; Herzog"
                            5 => "R&#46; Corey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00345-002-0301-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Urol"
                        "fecha" => "2003"
                        "volumen" => "20"
                        "paginaInicial" => "327"
                        "paginaFinal" => "336"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12811491"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health-related consequences of overactive bladder&#58; an economic perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;W&#46; Hu"
                            1 => "T&#46;H&#46; Wagner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-410X.2005.05654.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int"
                        "fecha" => "2005"
                        "volumen" => "96"
                        "paginaInicial" => "43"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16086679"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La severidad de la vejiga hiperactiva modifica la carga asistencial y la productividad laboral"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;C&#46; Angulo"
                            1 => "F&#46;J&#46; Brenes"
                            2 => "D&#46; Ochayta"
                            3 => "I&#46; Lizarraga"
                            4 => "D&#46; Arumi"
                            5 => "S&#46; Trillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acuro.2013.11.002"
                      "Revista" => array:3 [
                        "tituloSerie" => "Actas Urol Esp"
                        "fecha" => "2013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24210656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding the elements of overactive bladder&#58; question raised by the EPIC study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;E&#46; Irwin"
                            1 => "P&#46; Abrams"
                            2 => "I&#46; Milson"
                            3 => "Z&#46; Kopp"
                            4 => "K&#46; Reilly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-410X.2008.07573.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int"
                        "fecha" => "2008"
                        "volumen" => "101"
                        "paginaInicial" => "1381"
                        "paginaFinal" => "1387"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18336602"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence available on the use of the selective &#946;3-adrenoceptor agonist mirabegron for the treatment of overactive bladder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;C&#46; Angulo"
                            1 => "V&#46; Khullar"
                            2 => "V&#46;W&#46; Nitti"
                            3 => "E&#46; Siddiqui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acuro.2013.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Urol Esp"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "640"
                        "paginaFinal" => "651"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23850394"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Insight into new potential targets for the treatment of overactive bladder and detrusor overactivity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Cerruto"
                            1 => "A&#46;D&#46; Asimakopoulos"
                            2 => "W&#46; Artibani"
                            3 => "G&#46; del Popolo"
                            4 => "M&#46; La Martina"
                            5 => "R&#46; Carone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000339251"
                      "Revista" => array:6 [
                        "tituloSerie" => "Urol Int"
                        "fecha" => "2012"
                        "volumen" => "89"
                        "paginaInicial" => "1"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22738896"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Apostolidis"
                            1 => "P&#46; Dasgupta"
                            2 => "C&#46;J&#46; Fowler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2005.12.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2006"
                        "volumen" => "49"
                        "paginaInicial" => "644"
                        "paginaFinal" => "650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16426734"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuevo tratamiento para la vejiga hiperactiva&#46; Experiencia inicial en el tratamiento de la vejiga hiperactiva refractaria con toxina botul&#237;nica tipo A"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Rebassa"
                            1 => "G&#46; Conde"
                            2 => "M&#46; Cholvi"
                            3 => "G&#46; Briones"
                            4 => "A&#46; Mus"
                            5 => "M&#46; Blasco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Balear"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "28"
                        "paginaFinal" => "33"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vejiga hiperactiva y su manejo con toxina botul&#237;nica tipo A en el Hospital General de M&#233;xico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;J&#46; P&#233;rez"
                            1 => "M&#46;A&#46; Reyes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Mex Urol"
                        "fecha" => "2010"
                        "volumen" => "70"
                        "paginaInicial" => "228"
                        "paginaFinal" => "242"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The case for bladder botulinum toxin application"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;K&#46; Kim"
                            1 => "C&#46;A&#46; Thomas"
                            2 => "C&#46; Smith"
                            3 => "M&#46;B&#46; Chancellor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Urol Clin N Am"
                        "fecha" => "2006"
                        "volumen" => "33"
                        "paginaInicial" => "503"
                        "paginaFinal" => "510"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of urodynamic and detrusor contractility variables in patients with overactive bladder syndrome treated with botulinum toxin-A&#58; is incomplete bladder emptying predictable&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Sahai"
                            1 => "P&#46; Sangster"
                            2 => "V&#46; Kalsi"
                            3 => "M&#46;S&#46; Khan"
                            4 => "C&#46;J&#46; Fowler"
                            5 => "P&#46; Dasgupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-410X.2008.08076.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int"
                        "fecha" => "2009"
                        "volumen" => "103"
                        "paginaInicial" => "630"
                        "paginaFinal" => "634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18990156"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity&#58; clinical and urodynamic results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Giannantoni"
                            1 => "E&#46; Mearini"
                            2 => "M&#46; del Zingaro"
                            3 => "M&#46; Porena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2008.08.048"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2009"
                        "volumen" => "55"
                        "paginaInicial" => "705"
                        "paginaFinal" => "711"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18814955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pelvic floor disorders network&#46; Refractory idiopathic urge urinary incontinence and botulinum A injection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Brubaker"
                            1 => "H&#46;E&#46; Richter"
                            2 => "A&#46; Visco"
                            3 => "S&#46; Mahajan"
                            4 => "I&#46; Nygaard"
                            5 => "T&#46;M&#46; Braun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2008.03.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2008"
                        "volumen" => "180"
                        "paginaInicial" => "217"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18499184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update on the treatment of overactive bladder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;R&#46; Dmochowski"
                            1 => "A&#46; Gomelsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MOU.0b013e3283468da3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Urol"
                        "fecha" => "2011"
                        "volumen" => "21"
                        "paginaInicial" => "286"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21499104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Phase 3 efficacy and tolerability study of onabotulinumtoxin A for urinary incontinence from neurogenic detrusor overactivity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Ginsberg"
                            1 => "A&#46; Gousse"
                            2 => "V&#46; Keppenne"
                            3 => "K&#46;D&#46; Sievert"
                            4 => "C&#46; Thompson"
                            5 => "W&#46; Lam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2012.01.125"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2012"
                        "volumen" => "187"
                        "paginaInicial" => "2131"
                        "paginaFinal" => "2139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22503020"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of onabotulinumtoxin A in patients with urinary incontinence due to neurogenic detrusor overactivity&#58; a randomised&#44; double-blind&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Cruz"
                            1 => "S&#46; Herschorn"
                            2 => "P&#46; Aliotta"
                            3 => "M&#46; Brin"
                            4 => "C&#46; Thompson"
                            5 => "W&#46; Lam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2011.07.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2011"
                        "volumen" => "60"
                        "paginaInicial" => "742"
                        "paginaFinal" => "750"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21798658"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Onabotulinumtoxin A is effective in patients with urinary incontinence due to neurogenic detrusor activity regardless of concomitant anticholinergic use or neurologic etiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Ginsberg"
                            1 => "F&#46; Cruz"
                            2 => "S&#46; Herschorn"
                            3 => "A&#46; Gousse"
                            4 => "V&#46; Keppenne"
                            5 => "P&#46; Aliotta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12325-013-0054-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Ther"
                        "fecha" => "2013"
                        "volumen" => "30"
                        "paginaInicial" => "819"
                        "paginaFinal" => "833"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24072665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Onabotulinumtoxin A for the treatment of patients with overactive bladder and urinary incontinence&#58; results of a phase 3&#44; randomized&#44; placebo controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;W&#46; Nitti"
                            1 => "R&#46; Dmochowski"
                            2 => "S&#46; Herschorn"
                            3 => "P&#46; Sand"
                            4 => "C&#46; Thompson"
                            5 => "C&#46; Nardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2012.12.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2013"
                        "volumen" => "189"
                        "paginaInicial" => "2186"
                        "paginaFinal" => "2193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23246476"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Onabotulinumtoxin A 100<span class="elsevierStyleHsp" style=""></span>U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence&#58; a randomised&#44; double-blind&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Chapple"
                            1 => "K&#46;D&#46; Sievert"
                            2 => "S&#46; MacDiarmid"
                            3 => "V&#46; Khullar"
                            4 => "P&#46; Radziszewski"
                            5 => "C&#46; Nardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2013.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2013"
                        "volumen" => "64"
                        "paginaInicial" => "249"
                        "paginaFinal" => "256"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23608668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness of botulinum toxin A versus anticholinergic medications for idiopathic urge incontinence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Wu"
                            1 => "N&#46;Y&#46; Siddiqui"
                            2 => "C&#46;L&#46; Amundsen"
                            3 => "E&#46;R&#46; Myers"
                            4 => "L&#46;J&#46; Havrilesky"
                            5 => "A&#46;G&#46; Visco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2009.01.037"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2009"
                        "volumen" => "181"
                        "paginaInicial" => "2181"
                        "paginaFinal" => "2186"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19296983"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pelvic floor disorders network&#46; Anticholinergic versus botulinum toxin A comparison trial for the treatment of bothersome urge urinary incontinence&#58; ABC trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;G&#46; Visco"
                            1 => "L&#46; Brubaker"
                            2 => "H&#46;E&#46; Richter"
                            3 => "I&#46; Nygaard"
                            4 => "M&#46;F&#46; Paraiso"
                            5 => "S&#46;A&#46; Menefee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cct.2011.09.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Contemp Clin Trials"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "184"
                        "paginaFinal" => "196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22008247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A modified Delphi method approach to a new card sorting methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Lyn Paul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Usability Stud"
                        "fecha" => "2008"
                        "volumen" => "4"
                        "paginaInicial" => "7"
                        "paginaFinal" => "30"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Delphi method&#58; an experimental study of group opinion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46;C&#46; Dalkey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1969"
                        "editorial" => "Rand Corporation"
                        "editorialLocalizacion" => "Santa Monica &#40;California&#41;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An exploration of the use of simple statistics to measure consensus and stability in Delphi studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;A&#46; Holey"
                            1 => "J&#46;L&#46; Feeley"
                            2 => "J&#46; Dixon"
                            3 => "V&#46;J&#46; Whittaker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2288-7-52"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med Res Methodol"
                        "fecha" => "2007"
                        "volumen" => "7"
                        "paginaInicial" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18045508"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptom-based diagnosis of overactive bladder&#58; an overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Wein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5489/cuaj.11183"
                      "Revista" => array:7 [
                        "tituloSerie" => "Can Urol Assoc J"
                        "fecha" => "2011"
                        "volumen" => "5"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "S135"
                        "paginaFinal" => "S136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21989525"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urinary incontinence&#44; overactive bladder&#44; and other lower urinary tract symptoms&#58; a longitudinal population-based survey in men aged 45&#8211;103 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "U&#46;G&#46; Malmsten"
                            1 => "U&#46; Molander"
                            2 => "R&#46; Peeker"
                            3 => "D&#46;E&#46; Irwin"
                            4 => "I&#46; Milsom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2010.03.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2010"
                        "volumen" => "58"
                        "paginaInicial" => "149"
                        "paginaFinal" => "156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20356669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating overactive bladder in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Wagg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5489/cuaj.11188"
                      "Revista" => array:7 [
                        "tituloSerie" => "Can Urol Assoc J"
                        "fecha" => "2011"
                        "volumen" => "5"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "S149"
                        "paginaFinal" => "S151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21989530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validaci&#243;n psicom&#233;trica de las escalas OAB-V8 y OAB-V3 para la detecci&#243;n de pacientes con probable vejiga hiperactiva en la poblaci&#243;n espa&#241;ola"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Brenes"
                            1 => "J&#46;C&#46; Angulo"
                            2 => "D&#46; Ochayta"
                            3 => "J&#46; Rejas"
                            4 => "D&#46; Arum&#237;"
                            5 => "A&#46; Ca&#241;adas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Med Clin"
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of action of botulinum neurotoxins&#44; &#946;3-adrenergic receptor agonists&#44; and PDE5 inhibitors in modulating detrusor function in overactive bladders&#58; ICI-RS 2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Kanai"
                            1 => "I&#46; Zabbarova"
                            2 => "M&#46; Oefelein"
                            3 => "P&#46; Radziszewski"
                            4 => "Y&#46; Ikeda"
                            5 => "K&#46;E&#46; Andersson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/nau.21246"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurourol Urodyn"
                        "fecha" => "2012"
                        "volumen" => "31"
                        "paginaInicial" => "300"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22275187"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Therapeutic benefit in patients switching tolterodine to other novel antimuscarinic agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; S&#225;nchez-Ballester"
                            1 => "P&#46; Miranda"
                            2 => "I&#46; Lizarraga"
                            3 => "J&#46; Rejas"
                            4 => "D&#46; Arumi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acuro"
                      "Revista" => array:3 [
                        "tituloSerie" => "Actas Urol Esp"
                        "fecha" => "2013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24210656"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of refractory overactive bladder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46; Giarenis"
                            1 => "L&#46; Cardozo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Ginecol"
                        "fecha" => "2013"
                        "volumen" => "65"
                        "paginaInicial" => "41"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23412019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of antimuscarinic treatments in overactive bladder&#58; an update of a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;R&#46; Chapple"
                            1 => "V&#46; Khullar"
                            2 => "Z&#46; Gabriel"
                            3 => "D&#46; Muston"
                            4 => "C&#46;E&#46; Bitoun"
                            5 => "D&#46; Weinstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2008.06.047"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2008"
                        "volumen" => "54"
                        "paginaInicial" => "543"
                        "paginaFinal" => "562"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18599186"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and tolerability of mirabegron&#44; a &#946;&#40;3&#41;-adrenoceptor agonist&#44; in patients with overactive bladder&#58; results from a randomised European-Australian phase 3 trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Khullar"
                            1 => "G&#46; Amarenco"
                            2 => "J&#46;C&#46; Angulo"
                            3 => "J&#46; Cambronero"
                            4 => "K&#46; H&#248;ye"
                            5 => "I&#46; Milsom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2012.10.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2013"
                        "volumen" => "63"
                        "paginaInicial" => "283"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23182126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mirabegron for the treatment of overactive bladder&#58; a prespecified pooled efficacy analysis and pooled safety analysis of three randomised&#44; double-blind&#44; placebo-controlled&#44; phase <span class="elsevierStyleSmallCaps">iii</span> studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;W&#46; Nitti"
                            1 => "V&#46; Khullar"
                            2 => "P&#46; van Kerrebroeck"
                            3 => "S&#46; Herschorn"
                            4 => "J&#46; Cambronero"
                            5 => "J&#46;C&#46; Angulo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijcp.12194"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pract"
                        "fecha" => "2013"
                        "volumen" => "67"
                        "paginaInicial" => "619"
                        "paginaFinal" => "632"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23692526"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Solifenacin plus tamsulosin combination treatment in men with lower urinary tract symptoms and bladder outlet obstruction&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Kaplan"
                            1 => "W&#46; He"
                            2 => "W&#46;D&#46; Koltun"
                            3 => "J&#46; Cummings"
                            4 => "T&#46; Schneider"
                            5 => "A&#46; Fakhoury"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2012.07.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2013"
                        "volumen" => "63"
                        "paginaInicial" => "158"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22831853"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychometric validation of the Spanish version of the overactive bladder questionnaire short-form &#40;OABQ-SF&#41; to assess severity of symptoms and patient health related quality of life in subjects with overactive bladder"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Arlandis-Guzm&#225;n"
                            1 => "M&#46;A&#46; Ruiz"
                            2 => "C&#46; Errando-Smet"
                            3 => "F&#46; Villacampa-Aub&#225;"
                            4 => "M&#46; Garc&#237;a-Vargas"
                            5 => "D&#46; Arumi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Value Health"
                        "fecha" => "2010"
                        "volumen" => "13"
                        "paginaInicial" => "A479"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of botulinum toxin A intradetrusor injections in adults with neurogenic detrusor overactivity&#47;neurogenic overactive bladder&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "I&#46; Soljanik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40265-013-0068-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs"
                        "fecha" => "2013"
                        "volumen" => "73"
                        "paginaInicial" => "1055"
                        "paginaFinal" => "1066"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23775527"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An updated systematic review and statistical comparison of standardized mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mangera"
                            1 => "A&#46; Apostolidis"
                            2 => "K&#46;E&#46; Andersson"
                            3 => "P&#46; Dasgupta"
                            4 => "A&#46; Giannantoni"
                            5 => "C&#46; Roehrborn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2013.10.033"
                      "Revista" => array:2 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The management of overactive bladder refractory to medical therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Robinson"
                            1 => "I&#46; Giarenis"
                            2 => "L&#46; Cardozo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.maturitas.2013.01.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Maturitas"
                        "fecha" => "2013"
                        "volumen" => "75"
                        "paginaInicial" => "101"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23415926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pelvic floor electrostimulation in women with urinary incontinence and&#47;or overactive bladder syndrome&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Jerez-Roig"
                            1 => "D&#46;L&#46; Souza"
                            2 => "A&#46; Espelt"
                            3 => "M&#46; Costa-Mar&#237;n"
                            4 => "A&#46;M&#46; Belda-Molina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acuro.2012.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Urol Esp"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "429"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23246103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sacral neuromodulation effects on periurethral sensation and urethral sphincter activity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Gleason"
                            1 => "K&#46; Kenton"
                            2 => "W&#46;J&#46; Greer"
                            3 => "O&#46; Ramm"
                            4 => "J&#46;M&#46; Szychowski"
                            5 => "T&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/nau.22319"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurourol Urodyn"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "476"
                        "paginaFinal" => "479"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23168535"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735786/0000003800000004/v1_201405090042/S2173578614000262/v1_201405090042/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6273"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Special article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003800000004/v1_201405090042/S2173578614000262/v1_201405090042/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578614000262?idApp=UINPBA00004N"
]

Article information

ISSN: 21735786
Original language: English

DOI:10.1016/j.acuroe.2014.02.010

The statistics are updated each day

Year/Month	Html	Pdf	Total

2023 March	2	2	4
2018 February	4	4	8
2018 January	9	2	11
2017 December	6	1	7
2017 November	13	1	14
2017 October	13	2	15
2017 September	9	4	13
2017 August	13	1	14
2017 July	10	2	12
2017 June	22	16	38
2017 May	18	6	24
2017 April	13	5	18
2017 March	15	14	29
2017 February	9	4	13
2017 January	9	1	10
2016 December	14	8	22
2016 November	20	8	28
2016 October	25	4	29
2016 September	17	8	25
2016 August	17	2	19
2016 July	9	3	12
2016 June	13	10	23
2016 May	25	13	38
2016 February	0	3	3
2015 December	0	4	4
2015 November	2	1	3
2015 October	0	2	2
2015 August	0	1	1
2015 July	0	1	1
2015 May	1	0	1
2015 March	0	1	1
2014 December	0	1	1
2014 August	0	1	1
2014 June	2	0	2
2014 May	3	2	5

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter