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Original article
OnabotulinumtoxinA in urinary incontinence: Prospective study of a case series
Onabotulinumtoxin A en la incontinencia urinaria: estudio prospectivo de serie de casos
A. Martín-Martínez
Corresponding author
aliciammartinez@gmail.com

Corresponding author.
, A. Fernández-Mederos, J.Á. García-Hernández
Departamento de Obstetricia y Ginecología, Complejo Hospitalario Universitario Insular Materno-Infantil Las Palmas de Gran Canaria, Las Palmas, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Urinary incontinence &#40;UI&#41; is a common problem that affects women of all ages&#46; The prevalence of UI increases with age&#44; ranging from 7&#37; in women between 20 and 39&#44; and 32&#37; in women older than 80&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;2</span></a> The UI is an important economic cost&#46; In the United States in 2015&#44; the estimated total cost of patients with urge urinary incontinence &#40;UUI&#41; was 76&#46;2 million dollars&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Moreover&#44; the UI has an impact on the quality of life of women of all ages&#44; which include the elderly admitted to nursing homes&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Top-line UUI treatments include lifestyle changes&#44; urinal re-education&#44; pelvic floor muscle exercises&#44; and pharmacological treatment with anticholinergic drugs or beta-3 adrenergic receptor agonists&#46; However&#44; high rates of cessation of these treatments have been observed&#44; both in clinical trials and in usual clinical practice&#44; mainly not only due to the adverse effects associated with them&#44; but also to the lack of efficacy&#46; It is estimated that adherence to treatment is only 13&#37; during the first year&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Recently&#44; intravesical OnabotulinumtoxinA &#40;OnaBTA&#41; injections have been approved in the United States and Europe as second-line treatment for treatment in adults with refractory idiopathic UUI&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since Schurch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> reported that OnaBTA could improve urinary continence in patients with refractory detrusor overactivity&#44; many different studies have suggested its efficacy in patients with refractory UUI&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8&#8211;11</span></a> In addition&#44; the use of OnaBTA has also been recommended by the European Association of Urology<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a> and a panel of European experts gave it a grade A recommendation regarding its efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently&#44; a Spanish group published some evidence-based consensus recommendations&#44; where it was considered that OnaBTA may be used for OAB syndrome with UUI secondary to idiopathic or neurogenic detrusor overactivity for patients in whom conservative treatment has failed and first-line medical treatment is not tolerated or is contraindicated&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Currently&#44; there is a level of evidence A for the use of OnaBTA in patients with idiopathic urgency urinary incontinence inadequately controlled with anticholinergic&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This study aims to evaluate the efficacy and safety of a single intravesical application of 100 units of OnaBTA for the treatment of refractory urge incontinence in women&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0040" class="elsevierStylePara elsevierViewall">A prospective case series study was conducted in consecutive patients with refractory UUI treated with intravesical injections of OnabotulinumtoxinA &#40;Botox<span class="elsevierStyleSup">&#174;</span> Allergan&#44; Inc&#46;&#44; Irvine&#44; CA&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The protocol of the study was approved by the Ethics Committee of the University of Insular Women&#39;s and Children&#39;s Hospital&#46; All patients were informed of the details of the study protocol and the patients provided written informed consent prior to starting the study&#46; The ethical principles established in the Declaration of Helsinki and good clinical practice were followed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In this study&#44; only patients with pure UUI or with mixed UI but predominantly urgent were included&#46; Inclusion criteria for patient selection were the following&#58; women with persistent UUI symptoms&#44; defined as 2 or more UUI episodes in a 3-day urinary tract&#59; adults aged 18 or older&#59; UUI refractory to first-line treatment&#59; ability to comply with study protocol&#59; having a negative urine culture at the time of inclusion&#59; a value in the Sandvik gravity index greater than or equal to 6&#59; not receiving medical treatment with anticholinergics or beta-3 agonists &#40;anticholinergics and Beta-3 agonists were discontinued for at least 4 weeks before completion of the initial examinations&#41; and a normal neurological examination&#46; Patients were excluded if they presented any neurological alterations that could affect the urological function&#59; clinical or urodynamic signs of neurogenic bladder&#59; any condition that could be considered as contraindication to treatment with OnaBTA &#40;allergic reaction&#44; neuromuscular junction diseases&#44; peripheral neuropathies&#44; etc&#46;&#41;&#59; previous treatment of the external urethral sphincter with injections of OnaBTA&#59; sphincterotomy and pregnancy or lactation&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Refractory UUI was defined as persistent UUI symptoms after 2 rounds of medical treatment associated with conservative treatment &#40;behavioral therapy and&#47;or supervised physical therapy&#41;&#46; Each medical treatment should have been tested for at least a period of not less than 8 weeks&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All patients underwent urodynamic study before instillation of the OnaBTA and 6 months after the instillation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients were treated on an outpatient basis&#46; 30<span class="elsevierStyleHsp" style=""></span>cc of 2&#37; lidocaine was injected transurethrally into the bladder&#44; which acts during 20<span class="elsevierStyleHsp" style=""></span>min prior to the injection of OnaBTA&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Injections of OnaBTA contained a dose of 100 units of OnabotulinumtoxinA &#40;Botox<span class="elsevierStyleSup">&#174;</span> Allergan&#44; Inc&#46;&#44; Irvine&#44; CA&#41; diluted in 10<span class="elsevierStyleHsp" style=""></span>ml of 0&#46;9&#37; saline&#46; OnaBTA injections were given intradetrusor following the procedure of Schurch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> Twenty punctures of 0&#46;5<span class="elsevierStyleHsp" style=""></span>ml are performed&#44; avoiding the trigone&#44; using a 25<span class="elsevierStyleHsp" style=""></span>G needle guided by a 21 French cystoscope with 0 degree optics &#40;Karl Storz&#44; Tittlingen&#44; Germany&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Once the OnaBTA is administered&#44; it is verified that no adverse effects have occurred&#46; After assessing that the patient urinates adequately&#44; the patient is sent home without bladder catheter but with antibiotic treatment of fosfomycin 3<span class="elsevierStyleHsp" style=""></span>g in two separate doses for 48<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The treatment was considered successful if the patient remained continent for 6 months&#44; with total absence of urine leakage&#46; Partial success was defined as a leakage episode per day&#59; and failure as two or more urine losses per day&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The severity of leakage was evaluated according to the frequency and quantity of the leaks using the Sandvik scale&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Data collected at the start of the study included age&#44; medical&#47;surgical history of the patient&#44; body mass index&#44; Sandvik test&#44; time after UUI diagnosis&#44; daytime voiding frequency&#44; nighttime urine production&#44; number of compresses used per day&#44; episodes of loss of urine&#44; maximum bladder capacity &#40;determined by 3-day voiding diary&#41;&#44; maximum detrusor pressure&#44; and involuntary detrusor contraction &#40;IDC&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The variables analyzed in the study were the following&#58; Sandvik test&#44; daytime voiding frequency&#44; nighttime urine production&#44; episodes of loss of urine&#44; number of compresses used per day&#44; maximum bladder capacity&#44; and maximum detrusor pressure during the first involuntary detrusor contraction&#46; Study variables were collected prior to the administration of OnaBTA and at 6 months after the treatment&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">A standard statistical analysis was performed using the MedCalc program &#40;MedCalc Software&#44; Mariakerke&#44; Belgium&#41;&#46; Data were expressed as number &#40;percentage&#41;&#44; mean &#40;standard deviation&#41;&#44; mean &#40;95&#37; confidence interval&#41; or median &#40;95&#37; CI&#41;&#44; as appropriate&#46; We examined the distribution of continuous variables with a D&#8217;Agostino&#8211;Pearson test&#46; Comparisons were made between the pre- and post-treatment values for the following variables&#58; Sandvik test&#44; daytime voiding frequency&#44; nighttime urine production&#44; episodes of loss of urine&#44; number of compresses used per day&#44; maximum bladder capacity&#44; maximum detrusor pressure&#44; and involuntary detrusor contraction&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">If the quantitative variables followed a normal distribution&#44; the means were compared using the 2-tailed Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired and non-paired samples&#46; Univariate analysis of variance &#40;ANOVA&#41; was used to analyze possible differences between successful patients&#44; partial success&#44; and treatment failure&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In those variables that did not present a normal distribution&#44; the Wilcoxon test was used&#44; or the Mann&#8211;Whitney test&#44; as appropriate&#46; Categorical variables were compared using Chi-square test or Fisher&#39;s exact test&#44; as necessary&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">A <span class="elsevierStyleItalic">p</span>-value of less than 0&#46;05 was considered significant&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">We evaluated 357 patients of whom 210 met the inclusion&#47;exclusion criteria&#46; Of the 210 patients who met all the inclusion criteria and none of the exclusion criteria&#44; 6 were lost during follow-up&#46; A total of 204 of the 210 selected patients conducted a valid visit six months after the therapeutic application&#44; which included an urodynamic study&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The average &#40;standard deviation&#41; age was 56&#46;7 &#40;11&#46;7&#41; years&#46; The average body mass index &#40;95&#37; CI&#41; was 29&#46;4<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> &#40;28&#46;5&#8211;30&#46;9&#41;&#46; The median time &#40;95&#37; CI&#41; since UUI was diagnosed was 12 months &#40;12&#46;0&#8211;17&#46;0&#41;&#44; with a maximum of 81 and a minimum of 4 months&#46; The main demographic and clinical characteristics of the patients&#44; at the beginning of the study&#44; have been summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; After OnaBTA administration in 68 women &#40;33&#46;0&#37;&#41;&#44; IDC was observed during filling at the sixth month visit&#44; compared to the 160 patients &#40;78&#46;4&#37;&#41; who had IDC in the baseline urodynamic study performed before OnaBTA administration &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">After treatment with OnaBTA&#44; 110 &#40;53&#46;9&#37;&#41; patients remained continent for 6 months&#44; and were therefore considered a success&#46; However&#44; 57 &#40;27&#46;9&#37;&#41; experienced one episode of urinary leakage per day&#44; and 37 &#40;18&#46;2&#37;&#41; had two or more leakages per day&#46; At the baseline visit&#44; the mean daily leakage was 8&#44; with a confidence interval &#40;CI&#41; of 7&#8211;9&#46; It was found that 81&#46;8&#37; &#40;167 women out of 204&#41; experienced a clinical improvement&#44; which was expressed in a significant reduction in the number of daily leaks at six months after the therapeutic application&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">After six months of treatment with OnaBTA&#44; the following changes in urodynamic parameters were observed&#58; increase of maximum bladder capacity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and reduction in the maximum detrusor pressure &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Significant improvements were observed after administering OnaBTA in daytime voiding frequency&#44; nighttime urine production&#44; episodes of loss of urine&#44; number of compresses used per day and Sandvik test &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In the 94 patients who had at least one episode of incontinence per day at the end of the study&#44; the median value &#40;interquartile range&#41; Sandvik test decreased significantly &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; from 12 &#40;10&#8211;12&#41; at baseline to 1 &#40;0&#8211;2&#41; after the treatment with OnaBTA&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The possible influence of time elapsed from the diagnosis to the treatment with OnaBTA was analyzed&#46; In the study prior to the treatment&#44; there were no significant differences between the different variables of the study according to the time elapsed from the onset of symptoms to OnaBTA treatment&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Likewise&#44; there were no differences in the clinical and demographic variables of the patients who had a successful response to treatment and those with an unsuccessful response &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; before the treatment&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding the safety profile&#44; 8 &#40;3&#46;9&#37;&#41; patients had self-limiting hematuria during the procedure&#59; all cases were resolved spontaneously and did not require hospital stay&#46; One patient had an episode of pyelonephritis and 17 &#40;8&#46;3&#37;&#41; had lower urinary tract infection&#44; which was satisfactorily resolved with oral antibiotic treatment in all cases&#46; Nine &#40;4&#46;4&#37;&#41; patients required intermittent catheterization for acute urinary retention&#44; which in no case exceeded four weeks&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">Intravesical injections of OnaBTA provided a clinically significant improvement in patients with urge urinary incontinence refractory to treatment with anticholinergic&#47;Beta-3 agonists and conservative treatment&#46; In this study&#44; a complete continence was observed over a period of 6 months in 53&#46;9&#37; of the patients receiving OnaBTA treatment&#44; and in 27&#46;9&#37; only one leak per day was observed&#44; with the median leakage in the sample being eight episodes per day &#40;CI&#58; 7&#8211;9&#41;&#46; This means that after treatment with 100<span class="elsevierStyleHsp" style=""></span>U of OnaBTA&#44; the number of episodes of urinary incontinence was significantly reduced&#44; with 186 &#40;91&#46;2&#37;&#41; patients who had a decrease equal to or greater than 75&#37; in the number of episodes of incontinence compared to the start of the study&#46; These results are consistent with the published evidence&#44; in which the percentage of patients with urinary continence after administration of OnaBTA ranged from 31&#37; to 87&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#8211;19</span></a> In addition&#44; our results agree with Denys et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> who found that a complete continence occurred in 55&#37; of patients included in the study after injection of OnaBTA&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> On the other hand&#44; the results of our study are significantly better than those published by Nitti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> who observed after 3 months of administering OnaBTA that 22&#46;9&#37; of patients had complete continence compared to 54&#37; found in our study&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">One explanation for those results may be the differences in protocol design&#44; or differences between study populations&#46; In other words&#44; the initial situation of our patients could be more favorable than in the study by Nitti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> That could explain the results obtained in our study&#46; For example&#44; in the study by Nitti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> the average duration of overactive bladder was 6&#46;4&#44; whereas in our study it was 12 months&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In addition&#44; the proportion of patients who achieved a decrease equal or greater than 75&#37; in the number of urinary leakage episodes at 6 months of treatment compared to the initial situation was 91&#46;2&#37;&#46; These results are consistent with those exposed by Kennelly et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> They found that the proportion of patients who had a decrease between 50&#37; and 100&#37; of the number of urinary leakages with respect to baseline after 6 months of treatment ranged from 73&#37; to 94&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> In favor of our study&#44; it should be noted that a single dose of 100<span class="elsevierStyleHsp" style=""></span>U of OnaBTA was used&#44; while Kennelly et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> evaluated the effect of repeated injections of 200 or 300<span class="elsevierStyleHsp" style=""></span>U&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The results of our study also suggest a significant decrease in the voiding frequency&#44; both daytime and night&#46; In a randomized trial&#44; Chapple et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> assessed the effectiveness of 100<span class="elsevierStyleHsp" style=""></span>U of OnaBTA in patients with idiopathic OAB with three or more episodes of UUI episodes and eight or more urine leaks per day&#46; They were not adequately controlled with anticholinergic drugs&#46; They reported that OnaBTA significantly reduced UI episodes per day &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and observed a decrease&#44; compared to baseline&#44; of other symptoms of OAB&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> In our study&#44; the improvement of clinical and urodynamic variables was maintained for 6 months&#44; compared to the 12 weeks of study by Chappel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> As in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">10&#44;11&#44;18&#8211;22</span></a> we found significant changes in urodynamic parameters&#44; namely&#44; an increase in maximum bladder capacity and a maximum detrusor pressure &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; as well as a significant reduction of non-inhibited contractions during filling&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The negative impact of UI on the quality of life of patients has been well documented&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;23</span></a> contributing to the severity of the leakage&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In our study&#44; the severity of UI was measured with the Sandvik test&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">At the baseline of this study&#44; all 204 &#40;100&#37;&#41; patients included were classified as severe &#40;score greater than or equal to 6&#41;&#44; as it was one of the inclusion criteria&#46; After the treatment&#44; 26 patients &#40;12&#46;7&#37;&#41; continued to be classified as severe&#59; of the remaining&#44; 20 &#40;9&#46;8&#37;&#41; were classified as moderate and 158 &#40;77&#46;5&#37;&#41; patients were classified as mild or totally continent&#46; Therefore&#44; we can affirm that improvement was found in 87&#46;3&#37; &#40;178 women&#41; of the sample&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Regarding the safety profile&#44; as reported in other studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#44;20&#8211;22&#44;24&#8211;26</span></a> we found that the most common adverse events were urinary tract infections and acute urinary retention&#44; which were observed in 8&#46;3&#37; and 4&#46;4&#37; of the patients&#44; respectively&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The figures found in our study contrast with those published by Tincello et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> who found a rate of infection and urinary retention of 31&#37; and 16&#37;&#44; respectively&#46; The urinary retention figures in our study also differ from those observed by Osborn et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> who found urinary retention rates that required intermittent catheterization over an average period of 16 weeks of 35&#37;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">However&#44; although the incidence of urinary tract infections observed in our study &#40;8&#46;3&#37;&#41; was lower than that reported by Nitti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> &#40;15&#46;5&#37;&#41;&#44; the incidence of urinary retention was similar in both studies &#40;4&#46;4&#37; in our study versus 5&#46;4&#37; in the study by Nitti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a>&#41;&#46; Regarding the incidence of infections&#44; our results are in line with those observed by Abdelwahab et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a> who in a population of patients with idiopathic overactive bladder treated with 100<span class="elsevierStyleHsp" style=""></span>UI of OnaBTA found a rate of infection of 7&#46;5&#37;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Finally&#44; the incidence of hematuria&#44; urinary tract infections and urinary retention that required intermittent catheterization observed in our study was slightly lower than that reported by Kuo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> In the follow-up period&#44; they found that acute urinary retention occurred in 8&#37; of patients&#44; macroscopic hematuria in 8&#37; of patients&#44; and urinary tract infections in 14&#37;&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Regarding the safety profile&#44; in view of the available scientific evidence&#44; we can say that there is a great variability in the incidence of adverse effects&#46; This variability may be due to differences in the definitions used&#44; in the design of the studies&#44; or in the populations analyzed&#46; In general&#44; the incidence of adverse effects observed in our study was lower than the one published so far&#46; However&#44; we do not find a plausible explanation for this fact&#44; except for the one offered above&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Although it has not been the objective of this study&#44; it is interesting to mention that one of the main problems that arises with the long-term treatment with OnaBTA is adherence&#46; It has been reported that dropout rates can exceed 60&#37; after three years of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Moreover&#44; the results of a prospective study published in 2015<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> showed that adherence rates after 36 months of follow-up were around 20&#37;&#46; The main reasons for discontinuing the treatment were tolerability problems&#44; mainly urinary tract infections&#44; and the need for intermittent catheterization&#44; whereas loss of efficacy was less important&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">This study has a number of limitations to be mentioned&#44; including its open design&#46; However&#44; the application of strict inclusion&#47;exclusion criteria could reduce this bias&#46; The second limitation is that this is a single center study&#46; However&#44; a large number of patients have been included&#44; minimizing the impact of this limitation&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0225" class="elsevierStylePara elsevierViewall">According to the results of this study&#44; a single 100<span class="elsevierStyleHsp" style=""></span>UI injection of OnaBTA significantly reduced the frequency and severity of urinary incontinence episodes in patients with refractory UUI&#46; On the other hand&#44; the results of this study show the good safety profile of this drug&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "Incontinencia urinaria"
            1 => "Toxina botul&#237;nica"
            2 => "&#205;ndice de gravedad de Sandvik"
            3 => "Escapes de orina"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA &#40;OnaBTA&#41; for treating urge urinary incontinence &#40;UUI&#41; in women&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA&#46; The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta-3 agonists&#46; The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA&#46; The primary study endpoint was the number of episodes of urinary leakage&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application&#46; At 6 months of treatment with OnaBTA&#44; 110 &#40;53&#46;9&#37;&#41; patients remained continent and were considered a success&#46; However&#44; 57 &#40;27&#46;9&#37;&#41; patients experienced one episode of urinary leakage per day&#44; and 37 &#40;18&#46;2&#37;&#41; had 2 or more&#46; In terms of the urodynamic parameters&#44; we observed the following changes&#58; increase in maximum bladder capacity &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and reduced maximum pressure of the detrusor &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; In terms of the safety profile&#44; 8 &#40;3&#46;9&#37;&#41; patients had self-limiting haematuria during the procedure&#44; which resolved spontaneously&#44; and 9 &#40;4&#46;4&#37;&#41; patients had acute urinary retention that required intermittent catheterisation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la eficacia y seguridad de una inyecci&#243;n intravesical &#250;nica de Onabotulinumtoxin A &#40;OnaBTA&#41; en el tratamiento de la incontinencia urinaria de urgencia en mujeres&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo de serie de casos en pacientes consecutivas con incontinencia urinaria de esfuerzo refractaria tratadas con una inyecci&#243;n intravesical de OnaBTA&#46; Las pacientes recibieron 100 unidades de OnaBTA inyectada en la pared vesical despu&#233;s de 4 semanas de lavado de anticolin&#233;rgicos o agonistas beta 3&#46; Las variables urodin&#225;micas y cl&#237;nicas fueron evaluadas antes y 6 meses despu&#233;s de la inyecci&#243;n de OnaBTA&#46; La variable principal del estudio fue el n&#250;mero de episodios de escapes urinarios&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Un total de 204 de las 210 pacientes seleccionadas realizaron una visita v&#225;lida al sexto mes de la aplicaci&#243;n terap&#233;utica&#46; A los 6 meses del tratamiento con OnaBTA 110 &#40;53&#44;9&#37;&#41; pacientes permanecieron continentes y fueron consideradas como &#233;xito&#46; Por otro lado&#44; 57 &#40;27&#44;9&#37;&#41; presentaron un episodio de escape urinario por d&#237;a y 37 &#40;18&#44;2&#37;&#41; tuvieron 2 o m&#225;s&#46; En relaci&#243;n con los par&#225;metros urodin&#225;micos se observaron los siguientes cambios&#58; aumento de la capacidad vesical m&#225;xima &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y disminuci&#243;n de la presi&#243;n del detrusor m&#225;xima &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; En cuanto al perfil de seguridad&#44; 8 &#40;3&#44;9&#37;&#41; pacientes tuvieron hematuria autolimitada durante el procedimiento&#44; que se resolvi&#243; espont&#225;neamente&#59; 9 &#40;4&#44;4&#37;&#41; pacientes tuvieron una retenci&#243;n urinaria aguda que precis&#243; cateterizaci&#243;n intermitente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudio apoya el uso de onabotulinumtoxin A en pacientes con incontinencia urinaria de urgencia que no responden al tratamiento m&#233;dico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Mart&#237;n-Mart&#237;nez A&#44; Fern&#225;ndez-Mederos A&#44; Garc&#237;a-Hern&#225;ndez J&#193;&#46; Onabotulinumtoxin A en la incontinencia urinaria&#58; estudio prospectivo de serie de casos&#46; Actas Urol Esp&#46; 2017&#59;41&#58;458&#8211;464&#46;</p>"
      ]
    ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">MBC&#44; maximum bladder capacity&#59; SD&#44; standard deviation&#59; ULE&#44; episodes of urine leak&#59; DUF&#44; daytime urinary frequency&#59; NUF&#44; nighttime urinary frequency&#59; 95&#37; CI&#44; 95&#37; confidence interval&#59; BMI&#44; body mass index&#59; <span class="elsevierStyleItalic">n</span>&#44; number&#59; MDP&#44; maximum detrusor pressure&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#46;7 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;1&#8211;58&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#46;4 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;5&#8211;30&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sandvik test</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;0&#8211;12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">DUF</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;0&#8211;14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">NUF</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;0&#8211;5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">ULA &#40;episodes&#47;day&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;0&#8211;9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Compresses &#40;units&#47;day&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;0&#8211;7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">MBC <span class="elsevierStyleItalic">&#40;cc&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">194&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">187&#46;5&#8211;210&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">MDP &#40;cm H</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">O&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;0&#8211;53&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics at baseline&#46;</p>"
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      1 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BoNTA&#44; botulinum toxin A&#59; UIC&#44; uninhibited contractions&#59; MBC&#44; maximum bladder capacity&#59; ULE&#44; episodes of urine leak&#59; DUF&#44; daytime urinary frequency&#59; NUF&#44; nighttime urinary frequency&#59; 95&#37; CI&#44; 95&#37; confidence interval&#59; <span class="elsevierStyleItalic">n</span>&#44; number&#59; MDP&#44; maximum detrusor pressure&#59; IQR&#44; interquartile range&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Initial &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>204&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BoNTA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>204&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IQR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IQR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sandvik test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;0 &#40;10&#46;0&#8211;12&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;0&#8211;12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0 &#40;1&#46;0&#8211;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#8211;2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DUF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;0 &#40;13&#46;0&#8211;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;0&#8211;17&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0 &#40;8&#46;0&#8211;9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0&#8211;10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NUF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0 &#40;4&#46;0&#8211;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0&#8211;6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0 &#40;0&#46;0&#8211;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#8211;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ULE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0 &#40;7&#46;0&#8211;9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;0&#8211;12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0 &#40;0&#46;0&#8211;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#8211;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Compresses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;0 &#40;6&#46;0&#8211;7&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;0&#8211;8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0 &#40;0&#46;0&#8211;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0&#8211;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">194&#46;5 &#40;187&#46;5&#8211;210&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160&#46;0&#8211;234&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">310&#46;0 &#40;300&#46;5&#8211;318&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">267&#46;0&#8211;344&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MDP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;0 &#40;15&#46;0&#8211;53&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;3&#8211;62&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;0 &#40;13&#46;0&#8211;26&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;0&#8211;32&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Success &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>110&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Partial success &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Failure &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>37&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;4 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;0&#8211;57&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;2 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;7&#8211;60&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;1 &#40;12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;1&#8211;62&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;3 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;0&#8211;30&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;0 &#40;8&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;8&#8211;32&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;1 &#40;6&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1&#8211;31&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;759&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TEvol &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;1 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;1&#8211;21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;6 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;5&#8211;22&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;9 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;9&#8211;24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;707&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sandvik&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;7 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&#8211;11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;3 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8&#8211;10&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;9 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&#8211;11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;229&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DUF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;4 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;7&#8211;15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;0 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;0&#8211;16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;0 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;9&#8211;15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;403&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NUF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7&#8211;5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#8211;5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1&#8211;5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;723&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ULE &#40;episodes&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;2&#8211;9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;2 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1&#8211;10&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;9 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735786
Original language: English
DOI:10.1016/j.acuroe.2017.01.002
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