Effectiveness of nursing care after surgery for stress urinary incontinence

This study was conducted in two stages with 32 Turkish women undergoing surgery for correction of stress urinary incontinence. In Stage 1, 13 subjects (Group 1) were recruited for interviews and observations of their nursing care needs. Stage I also involved the development of a patient education pamphlet, nursing care protocol, and a standard nursing care plan. In Stage II, a new group of 19 subjects (Group 2) were recruited. Preoperative education and the patient education pamphlet developed during Stage I were provided to Group 2 subjects. A standard nursing care plan and nursing care protocol were also applied in the postoperative period for Group 2 subjects. The study protocol implemented by Turkish nurses and physicians is detailed. Study results are also described and discussed.

Treatment options for patients with suboptimal response to surgery for stress urinary incontinence

BACKGROUND

Many women with stress urinary incontinence (SUI) undergo surgery to relieve their symptoms. Currently, tension-free vaginal tape or transobturator tape sling procedures are the surgical treatments of choice. Although these procedures are often successful, a growing number of women experience suboptimal results ranging from improvement without cure to postoperative failure. Follow-up surgery often improves residual or recurrent symptoms but generally carries lower success rates and higher complication risks. Additionally, many women with suboptimal results are reluctant to undergo further surgery.

SCOPE

A PubMed literature search for studies of SUI treatment options published from 1986 to 2006 was performed.

FINDINGS

The literature revealed a gap in published studies addressing non-surgical options for patients with failed SUI surgeries. Studies of non-surgical treatments for SUI often exclude women who have had prior surgeries, or do not analyze this subgroup. It is, therefore, difficult to assess non-surgical treatment options for women with failed surgeries. Women whose residual or recurring SUI is attributable to intrinsic sphincter deficiency may instead elect the injection of a bulking agent. Bulking agents are associated with a low rate of complications but frequently require several injections to be successful. Women experiencing suboptimal surgical results whose SUI is attributable to hypermobility may select a new non-surgical treatment, radiofrequency collagen denaturation. This non-invasive procedure has also demonstrated a low rate of complications.

CONCLUSIONS

Considering the effect of SUI symptoms on women's quality of life, and with more women experiencing suboptimal results after surgery for SUI, it is important to assess alternatives to further surgery.

Short-term efficacy of group pelvic floor training under intensive supervision versus unsupervised home training for female stress urinary incontinence: A randomized pilot study

AIMS

Current management guidelines propose pelvic floor muscle training (PFMT) as first line treatment for female stress urinary incontinence (SUI). The aim of this study is to compare the efficacy of group PFMT under intensive supervision to that of individual home therapy in women with SUI.

MATERIAL AND METHODS

Thirty women with clinical and urodynamic diagnosis of SUI were randomized in two equal-number groups. Following a common demonstration course, Group A women received a detailed schedule for home training, while Group B in addition attended a weekly hospital group visit. At 12 weeks both groups were assessed for changes in subjective and objective outcomes.

RESULTS

Twenty-two women, (10 Group A, 12 Group B) with a mean age of 47.3 years completed the study. Although significant (P<0.05) improvements were noted in both groups in quality of life scores, number of incontinence episodes/week, 24-hr frequency, and endurance, repetitions and fast contractions upon vaginal assessment of the PFMs, comparative analysis at the end of the study demonstrated significantly better results for women in Group B, who also improved in daily pad usage, underwear wetting, modified Oxford grading of the PFMs and hold with cough. Consequently, significantly more women in Group B reported improvement in their continence (100% vs. 20% in Group A).

CONCLUSIONS

Group PFMT under intensive supervision produced significantly better improvements in primary and secondary outcomes in the short-term compared to individual, unsupervised home application of PFMT.

A cross-sectional study of knowledge and practice of pelvic floor exercises during pregnancy and associated symptoms of stress urinary incontinence in North-East Scotland

OBJECTIVES

to establish levels of knowledge about pelvic floor exercises during pregnancy; reported practice of pelvic floor exercises in pregnancy; and prevalence of stress urinary incontinence in a sample of women in the third trimester of pregnancy.

DESIGN

structured cross-sectional interview survey.

PARTICIPANTS

pregnant women over the age of 16 years and more than 30 weeks gestation attending antenatal clinics in North-East Scotland. Of 350 women who agreed to participate, 289 (82.6%) were interviewed between July 1999 and March 2000.

FINDINGS

225 women (77.9%) reported being given or obtaining information about pelvic floor exercises in the current pregnancy. Books were the most frequently mentioned source of information. Midwives were the health professionals most likely to give information about pelvic floor exercises. Younger women, first-time mothers and those from more deprived backgrounds were less likely to report having information about the exercises. A third of women (n=90, 31.1%) said that they would have liked more information about the exercises. Practice of the exercises during pregnancy was reported by just over half the sample (n=156, 54.0%) and more than once a day by 26.3% (n=76). Younger women, and those from more deprived backgrounds, were less likely to report the practice of exercises. No difference was found in reported practice according to parity. More than half (n=157, 54.3%) of the women reported incontinence during the current pregnancy. No relationship was found between reported practice of pelvic floor exercises and stress urinary incontinence.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

the number of women who indicated a desire for more information and the low number who reported practice of the exercises suggest that improvements could be made. The gaps in information provision and practice suggest areas for future health promotion about the exercises, particularly by midwives, as not all women are seen by a physiotherapist during pregnancy. Reported levels of incontinence during pregnancy confirm previous findings and highlight the prevalence of incontinence in pregnancy.

Intravesical resiniferatoxin for the treatment of women with idiopathic detrusor overactivity and urgency incontinence: A single dose, 4 weeks, double-blind, randomized, placebo controlled trial

AIMS

To assess the hypothesis that resiniferatoxin (RTX) can be useful in women with urgency incontinence and idiopathic detrusor overactivity (IDO), we conducted a prospective, double-blind, randomized, placebo-controlled, parallel trial comparing the effects of RTX and placebo.

MATERIALS AND METHODS

Fifty-eight patients were randomly assigned to receive a single intravesical dose of 100 ml of either RTX 50 nM or placebo. Safety and efficacy were evaluated over 4 weeks. The primary efficacy endpoints were voiding symptoms evaluated through the voiding diary. Secondary efficacy endpoint was urodynamic response. Quality of life was measured by the Kings' Health Questionnaire

RESULTS

Although improving trends were seen in both groups after the instillations, no statistically significant differences were found between the groups in any of the clinical or urodynamic parameters. RTX instillations were well tolerated with few and self-limited side-effects.

CONCLUSION

A single 50 nM intravesical dose of RTX was not better than placebo for the treatment of women with IDO and urgency incontinence.

Impact of stress urinary incontinence and overactive bladder on quality of life in Thai women attending the urogynecology clinic

OBJECTIVE

To investigate the impact of stress urinary incontinence (SUI) and overactive bladder (OAB) on the quality of life (QOL) using disease specific health-related QOL questionnaire.

MATERIAL AND METHOD

Three hundred and nineteen women with SUI and/or OAB, attending the urogynecolgy clinic, Ramathibodi Hospital were recruited in the present study. Information on QOL was collected, using the Thai version of modified incontinence-specific quality of life questionnaire (I-QOL) and short form incontinence impact questionnaire (IIQ-7).

RESULTS

In 319 cases, the diagnosis of SUI, OAB, and both were 55 cases, 78 cases, and 186 cases, respectively. There was no statistically significant difference in patients' characteristics in three groups. The patients with both SUI and OAB showed significantly lower scores in all domains of I-QOL than the SUI and OAB groups, whereas QOL, assessed by IIQ-7, showed significant impairment in the combined SUI and OAB group, only in the emotional health domain.

CONCLUSION

Stress urinary incontinence and overactive bladder have a detrimental impact on patient health-related QOL. Women with a combination of SUI and OAB have the greatest impairment in QOL.

Quality of life and continence 1 year after the tension-free vaginal tape operation

OBJECTIVE

The purpose of this study was to evaluate changes in condition-specific and generic quality of life (QOL) and continence rates 1 year after the tension-free vaginal tape (TVT) operation for stress urinary incontinence.

STUDY DESIGN

A total of 99 patients undergoing the TVT operation underwent clinical and urodynamic assessment and completed the German language King's Health Questionnaire (KHQ) and the Short Form 36 (SF-36) before and 3 and 12 months after surgery. Overall, 72 TVTs were performed as isolated procedure and 27 in combination with other operations. Data were analyzed with the Chi-square test, analyses of variance, and the Tukey test.

RESULTS

Overall, the objective continence rate was 80% at 1 year and did not differ significantly between patients with or without concomitant surgery. Significant and clinically relevant (>10 points) improvements were seen in all domains of the KHQ except General Health perception. The SF-36 showed statistically significant but not clinically significant improvement.

CONCLUSION

The TVT operation is associated with improved condition-specific QOL in women with stress urinary incontinence. The condition-specific KHQ is more appropriate than the generic SF-36 for evaluating treatment results in women treated for incontinence.

Sexual function following surgery for urodynamic stress incontinence

The objective of this study was to compare sexual function in women before and after surgery for urodynamic stress incontinence in the absence of pelvic organ prolapse. This was a prospective questionnaire survey. Fifty-four women undergoing surgery (tension-free vaginal tape/tension-free vaginal tape-obturator) for urodynamic stress incontinence with no evidence of detrusor overactivity or concomitant prolapse were assessed preoperatively and 6 months post operatively. Assessment was based on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), the International Consultation on Incontinence Questionnaire (ICIQ) and the Patient Global Impression of Improvement. Paired t-tests were used for comparing pre- and post-op scores and unpaired t-tests for comparing observations between groups. Spearman's rank correlation was used for testing whether two numerically scored items were related, and McNemar test was used to compare pre- and postoperative responses to individual questions. ICIQ scores showed significant improvement after surgery (p < 0.001). Women completing PISQ were significantly younger (mean = 54) than those who did not (mean = 65; p < 0.001). The total PISQ score was better postoperatively (preoperative = 87.2, postoperative = 92.7; p < 0.001), with improvements in both the physical (preoperative = 31.0, postoperative = 35.2; p < 0.001) and partner-related domains (preoperative = 18.8, postoperative = 19.9; p = 0.002) but no improvement in behaviour emotive domains (preoperative = 37.3, postoperative = 37.6; p = 0.70). There was a reduction in episodes of coital incontinence postoperatively (preoperatively = 16/54, postoperatively = 39/54; p < 0.002). Previous vaginal surgery, oestrogen status of respondents and hysterectomy status did not affect the PISQ. Surgical correction of stress incontinence is associated with an improvement in sexual function.

Clinical and quality-of-life outcomes in women treated by the TVT-O procedure

OBJECTIVES

To objectively assess the success rate at 6 months after tension-free vaginal tape obturator (TVT-O) procedure. To assess subjective success rates, complications, patient satisfaction, and quality of life (QOL).

DESIGN

A prospective observational study.

SETTING

A tertiary referral urogynaecology practice.

POPULATION

A cohort of 100 consecutive women who underwent the TVT-O procedure between March and October 2004.

METHODS

The TVT-O technique was performed as described. Three standardised QOL questionnaires were completed preoperatively at 6 months and 12 months. At 6 months, a urogenital history, visual analogue scale score (VAS) for patient satisfaction, uroflow, and urinary stress test were performed. After 12 months, a urogenital history and patient satisfaction verbal analogue score (VeAS) were obtained by telephone interview.

MAIN OUTCOME MEASURE

Objective success rate of the TVT-O procedure was measured by negative stress test. Secondary outcomes were subjective success rates at 6 and 12 months, pre- and postoperative comparison of urodynamic parameters, complications, postoperative symptomatology, QOL analysis, and patient satisfaction.

RESULTS

Mean follow up was 18.5 months. Objective success rate was 95%. Subjective success rates were 92 and 84% at 6 and 12 months. Complications included recurrent urinary tract infection (six), voiding difficulty (two), persistent groin discomfort (three), haematoma (one), wound infection (one), vaginal tape erosion (one), and urethral irritation (one). Prevalence of de novo urge incontinence was 4.1 and 4.8% at 6 and 12 months. QOL analysis showed significant improvements in QOL scores postoperatively. Visual and verbal analogue scores indicated high patient satisfaction (VAS, VeAS >or= 80%) in 77 and 67% at 6 and 12 months.

CONCLUSION

The TVT-O is a safe and effective treatment for female stress urinary incontinence.

Duloxetine in the treatment of women with stress urinary incontinence: results from DESIRE (Duloxetine Efficacy and Safety for Incontinence in Racial and Ethnic populations)

OBJECTIVE

To evaluate the effectiveness and safety of duloxetine for the treatment of African-American and Hispanic women with stress urinary incontinence.

RESEARCH DESIGN AND METHODS

The 10-week (a 2-week lead in period followed by 8 weeks of active treatment), open-label, multicenter study of duloxetine 40 mg twice daily included women with stress urinary incontinence or stress predominant mixed incontinence. Efficacy was measured by the median percent change from baseline to endpoint of weekly incontinence episode frequency. The primary objective assessed the treatment response in a pre-specified group of women (n = 2960; 2321 Caucasian, 271 African-American, and 368 Hispanic) with similar baseline incontinence and comorbidity characteristics as the subjects enrolled in the placebo-controlled trials of duloxetine for the treatment of stress urinary incontinence. The efficacy in African-American and Hispanic women was compared with Caucasians using a predefined non-inferiority subpopulation analysis. Safety measures included adverse events, laboratory test results, and vital signs.

RESULTS

All three subgroups reported significant (all p < 0.001) median percent decreases in weekly incontinence episode frequency: -65.7% (African-American), -73.0% (Hispanic), and -75.0% (Caucasian). Non-inferior efficacy was demonstrated for African-American and Hispanic women compared to the Caucasian women. Common adverse events included nausea (21.8%, 28.0%, 25.3%), dry mouth (7.7%, 11.4%, 11.9%), and fatigue (9.2%, 5.7%, 11.6%) for the African-American, Hispanic, and Caucasian groups, respectively.

CONCLUSION

Duloxetine was efficacious and well tolerated for the treatment of African-American, Hispanic, and Caucasian women with stress urinary incontinence. The trial design was successful in enrolling a diverse population of patients. The most important limitations include the lack of placebo control, the short study duration, and the exclusion of patients with less than seven incontinence episodes per week.

Quality of life in women with stress urinary incontinence

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity.

Construct validity of the incontinence severity index

AIMS

To assess the construct validity of the incontinence severity index (ISI) by testing its correlation with two health-related quality of life measures, the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7), in women with urodynamic stress incontinence.

MATERIALS AND METHODS

A cohort of 170 women with the urodynamic stress incontinence who underwent corrective surgery completed the ISI, IIQ-7, and the UDI-6 both pre- and post-treatment. We correlated the pre- and post-treatment responses between the ISI, the IIQ-7, the UDI-6 and their subscales. We also assessed the sensitivity of the ISI to change by correlating the percent change in score between the three instruments. The results were analyzed using a non-parametric test of correlation, the Spearman's rho.

RESULTS

The ISI scores were generally not well correlated with the pre-treatment IIQ-7 and UDI-6 scores (r < 0.40). The post-treatment scores and percent change from pre- to post-treatment of the ISI, however, were highly correlated with that of the IIQ-7 and UDI-6 (r's > 0.70, P < 0.001). The ISI was most highly correlated with the UDI-6 stress symptoms subscale and most poorly correlated with the UDI-6 obstructive/discomfort subscale.

CONCLUSIONS

This study provides valuable insight into the construct validity of the ISI. Evidence of its convergent validity is found in the high correlation with the stress symptoms subscales of the UDI-6, while the poorer correlation with the obstructive subscale provides evidence of its divergent validity. These data also suggest that the ISI is highly sensitive to change seen with treatment.

Feasibility and patient satisfaction with pelvic organ prolapse and urinary incontinence day surgery

We performed a prospective cohort study to characterize the feasibility of urinary stress incontinence and pelvic organ prolapse surgery in day care. Two hundred and one women were prepared for day surgery by a standardised protocol; 132 women underwent a single Tension-free Vaginal Tape/Tension-free Vaginal Tape-Obturator procedure, and 69 women had additional or only pelvic organ prolapse surgery. The main outcome measures were complications, satisfaction score and recommendation to others, recorded after 3 days and 6-10 weeks. We found that it is feasible and safe to perform pelvic organ prolapse and urinary incontinence surgery in day care. Patients' satisfaction is high in all aspects of care and the majority would recommend it to others. In multivariate logistic regression analysis, only dissatisfaction with the care provided by the staff of the surgical ward was significantly associated with a negative recommendation to others (odds ratio 7.3, 95% confidence interval 1.6-33.5).

Pelvic floor exercises with biofeedback for stress urinary incontinence

OBJECTIVE

Prospective study to objectively evaluate the benefits of pelvic floor strengthening exercises associated to biofeedback for the treatment of stress urinary incontinence.

MATERIALS AND METHODS

Fourteen patients diagnosed with stress urinary incontinence (SUI) were selected for this study. All patients underwent a pelvic floor training associated to biofeedback for 12 consecutive weeks. Urodynamic tests, pad test and bladder diary were analyzed at the beginning of the study, at the end and after 3 months. The King's Health Questionnaire (KHQ) was applied before and after treatment to assess the impact in the quality of life.

RESULTS

There was a significant reduction in the pad weight (from 14.21 g to 1 g), number of urinary leakage episodes (from 8.14 per day to 2.57 per day) and daytime frequency (from 7.93 per day to 5.85 per day). At urodynamics the authors observed a significant increase in Valsalva leak-point pressure (from 103.93 cm H2O to 139.14 cm H2O), cistometric capacity (from 249.29 mL to 336.43 mL, p = 0.0015) and bladder volume at first desire to void (from 145 mL to 215.71 mL). Those differences were kept during the first 3 months of follow up. The KHQ revealed significant differences except in the case of ''general health perception'', which covers health in general and not exclusively urinary incontinence.

CONCLUSION

Treatment of SUI with pelvic floor exercises associated to biofeedback caused significant changes in the parameters analyzed, with maintenance of good results 3 months after treatment.

Female stress urinary incontinence: how do patient and physician perspectives correlate in assessment of outcomes?

PURPOSE OF REVIEW

This article discusses outcome assessment following surgery for incontinence, by correlating patient perspectives with that of the physician.

RECENT FINDINGS

A review of the literature demonstrates a large variance in the 'success rates' published for different stress urinary incontinence procedures. We review the elements essential in formation of a universal and valid incontinence questionnaire. Studies have attempted to correlate common clinical measures (voiding diaries, pad testing, urodynamics) with quality-of-life questionnaires. Sentinel articles in incontinence outcome assessment are discussed. Studies with critical measures of outcome are examined using the recommendations made by the Female Stress Urinary Incontinence Guidelines Panel summary report. Through presentation of our data on tension-free vaginal tape procedures, we give insight into the future of stress urinary incontinence research and outcomes.

SUMMARY

Early 'cure rates' were severely limited by their retrospective nature and focus on chart review and physician assessment. Symptom and quality-of-life questionnaires provide subjective outcome assessments. No direct correlation exists between universally accepted objective and subjective measures of improvement. Recent studies are getting closer to the female stress urinary incontinence guidelines. Yet, the pursuit for a universal definition of success continues, in order to bridge patient and physician perspectives on cure.

Recent developments in stress urinary incontinence in women

This article provides an overview of stress urinary incontinence (SUI) and current treatments. The role of the specialist nurse is also explored. It is recommended that conservative treatment is offered to all women with SUI.

Multiple sclerosis, body image and sexuality

Janet Hutchinson explores the concept of body image and sexuality in relation to a female client with bladder dysfunction and multiple sclerosis. She also discusses the psychological and social problems that may arise from these problems.

A survey of help-seeking and treatment provision in women with stress urinary incontinence

OBJECTIVE

To establish the prevalence of treatment-seeking in women with stress urinary incontinence (SUI), the extent and type of treatment provision, and the levels of unmet need in women who have and have not accessed care, as SUI in women is common but only a small proportion seek help, and there are reports suggesting that few women receive appropriate treatment.

SUBJECTS AND METHODS

A cross-sectional postal survey was conducted in which questionnaires were sent to a random sample of community-dwelling women aged > or = 40 years, registered with participating general practitioners (GPs) and living in Leicestershire. The questionnaires addressed urinary symptoms and their impact on quality of life, and service use in the preceding 12 months; 15 359 questionnaires were mailed and 9340 (60.8%) were returned complete.

RESULTS

Of the respondents, 7.7% reported SUI monthly or more often, and 15% of those had sought help. Help-seekers reported more severe symptoms and greater impact on quality of life. Most (78%) had spoken to their GP, and 77% had received some form of treatment or advice, but only 35% had received recommended treatments. The effects on quality of life were not related to treatment provision.

CONCLUSIONS

Most women with SUI are treated in primary care; access to appropriate treatments is poor and may, in part, be the cause of the high levels of unmet need observed in this study. Health education interventions may aid appropriate help-seeking and self-care strategies.

The impact of overactive bladder, stress and mixed urinary incontinence on quality of life in Thai postmenopausal women

OBJECTIVE

To assess the quality of life (QOL) of Thai postmenopausal women with overactive bladder (OAB), stress urinary incontinence (SUI) and mixed urinary incontinence (MUI).

MATERIAL AND METHOD

A total of 420 Thai postmenopausal women (120 had SUI, 60 MUI, 120 OAB and 120 controls) were recruited QOL was assessed by the Thai version short form 36 (SF-36).

RESULTS

There was no significant difference in the patients's characteristics. All domains of SF-36 in women with OAB, SUI and MUI were statistically significantly lower than the control group. OAB and MUI had lower SF-36 scores than SUI in all domains except the role of physical health. When compared between OAB and MUI, the women with MUI had lower SF-36 scores than OAB in all domains (except the physical functioning and general health).

CONCLUSION

OAB, SUI and MUI had more significant impaired QOL than control. The author found a greater impact on QUL in OAB and MUI in Thai postmenopausal women.

What is the effect of overactive bladder symptoms on woman's quality of life during and after first pregnancy?

OBJECTIVE

To evaluate the effect of overactive bladder symptoms (OAB) on women's quality of life (QoL) during and after the first pregnancy, using self-reported symptom-based QoL questionnaires.

PATIENTS AND METHODS

In a prospective cohort study, 474 women were asked to complete four self-reported questionnaires. Urogenital symptoms were assessed with the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). A women was considered to experience 'dry' OAB if she replied positively to the following two questions: 'do you experience a strong feeling of urgency to empty your bladder?'; and 'do you experience frequent urination?'. A women was considered to experience 'wet' OAB if she replied positively to all of the following questions: 'do you experience a strong feeling of urgency to empty your bladder?'; 'do you experience frequent urination?'; and 'do you experience urine leakage related to the feeling of urgency?'.

RESULTS

In all, 344 (72.6%) women who returned all four questionnaires were included in the analysis. After first childbirth there was a rapid decline in the prevalence of dry OAB (45.2% to 7.9%, P < 0.001). In pregnancy the prevalence of wet OAB increased significantly, but a year after childbirth the prevalence of wet OAB decreased and was similar to that at 12 weeks of gestation (P = 0.289). Women with wet OAB had higher scores on all IIQ domains than those with no OAB symptoms at 36 weeks of gestation. Women with dry or wet OAB all had higher scores on the mobility domain than those with no OAB. The scores on the physical, social and emotional functioning domains were low, suggesting a minimal restriction of lifestyle.

CONCLUSION

OAB symptoms are common during pregnancy; dry OAB had no negative effect on QoL, whereas wet OAB compromised QoL both during and after pregnancy, mainly in the 'mobility' and 'embarrassment' domains. The urge urinary incontinence symptom in wet OAB seems to profoundly compromise QoL. Apparently, in young mothers with wet OAB, limitations in mobility are especially stressful and these symptoms can be embarrassing.

Do women with urinary incontinence really know where all the toilets are? The toilet paper

AIMS OF STUDY

Aim of this study was to determine if women with overactive bladder really do have a more detailed knowledge about toilets and their conditions in their vicinity in comparison to women with urinary stress incontinence and those without any urinary symptoms.

PATIENTS AND METHODS

A questionnaire survey of 270 women from three symptom groups, those with stress incontinence, overactive bladder and controls without any bladder symptoms from an inner city area and two local towns. The knowledge of the three groups was compared and measured by a score assessed by the authors who had visited the toilets themselves.

RESULTS

Women with overactive bladder are more likely to exhibit precautionary voiding prior to leaving home and have significantly more detailed knowledge about toilets in their neighbourhood.

DISCUSSION

The overactive bladder seems to have a greater influence on behaviour and on quality of life than stress incontinence which could mean that they are more tortured by their symptoms.

Suburethral sling using the transobturator approach: a quality-of-life analysis

OBJECTIVE

The objective of the study was to determine the degree of benefit of a transobturator midurethral polypropylene sling in patients with stress urinary incontinence through a quality-of-life instrument and outcome analysis.

STUDY DESIGN

Forty-seven patients completed the validated Individual Incontinence Impact Questionnaire both before and after treatment. Subjects also completed the validated Patient Satisfaction Questionnaire postoperatively to complete outcome analysis. Statistical analyses included a paired Student t test for intrapair comparisons and 2-sample t tests to compare mean differences between groups.

RESULTS

Individual Incontinence Impact Questionnaire scores for the entire sample declined from a preoperative mean of 43.0 +/- 27.0% to a postoperative mean of 11.8 +/- 16.4 (P < .0001). On review of Patient Satisfaction Questionnaire responses, 45 patients (95.7%) were completely satisfied or somewhat satisfied, and 42 subjects (89.4%) stated their leakage was much better or better.

CONCLUSION

The transobturator midurethral sling provides a significant improvement in quality-of-life and high postoperative patient satisfaction.

Risk factors of voiding dysfunction and patient satisfaction after tension-free vaginal tape procedure

This study was undertaken to identify risk factors for postoperative voiding dysfunction and factors having impact on patient global satisfaction after a tension-free vaginal tape (TVT) procedure. Two hundred and eighty-five women who underwent the TVT procedure for stress urinary incontinence were analyzed to identify risk factors predictive of voiding dysfunction. Postoperative voiding dysfunction was defined as a peak urinary flow rate (PFR) <10 mL/sec (straining voiding, n = 17) or residual urine volume >30% of bladder capacity (incomplete emptying, n = 13). The global satisfaction rate was 91.6%. Voiding dysfunction developed in 29 (10.2%) patients. Among the factors, PFR was only factor of significance for voiding dysfunction. There was no significant difference between patients with and without voiding dysfunction in terms of their satisfaction. But postoperative PFR <10 mL/sec significantly compromised global satisfaction after the surgery. In those patients with a preoperative PFR <20 mL/sec, there were more patients with postoperative PFR <10 mL/sec. Peak urinary flow rate is an important factor for the postoperative voiding dysfunction. The inevitable decline in PFR can compromise patients' satisfaction with the procedure, when their postoperative PFR was <10 mL/sec.

[Geriatric urology -- incontinence in the elderly]

Urinary incontinence is a major problem in elderly patients. Severe underreporting of symptoms in combination with a reluctance of health professionals to ask about continence problems lead to a relevant illness burden. Individual psychological distress and reduction in self-perceived quality of life ending in social isolation cause significant subsequent morbidity. Therefore active case finding for continence-problems is an important obligation for health care providers, since effective pharmacological, non-pharmacological and surgical treatment-options are available. A combination of different therapeutic modalities often leads to an appreciable improvement of the symptoms, and sometimes a cure even in old patients. Therapeutic options and prognosis of different treatment approaches should be discussed in an unbiased manner with patients.

Factors influencing self-perceived disease severity in women with stress urinary incontinence combined with or without urge incontinence

AIMS

The aim of this study was to assess the impact of patient-perceived disease severity (PPDS) on the quality of life (QoL) of women with urinary incontinence (UI) and to identify factors predicting PPDS.

METHODS

A total of 109 women (mean age 54.9; range 31-77) with stress UI combined with or without urge UI were included in the primary analyses. The incontinence quality of life (I-QoL) devised during the course of this study was used to assess the QOL impact of UI.

RESULTS

PPDS of women with UI increased as I-QoL scores decreased (P<0.001). When analyzed by patient characteristics and objective test results, PPDS increased only with the number of episodes (P=0.005) and pad test weight increased (P=0.010). By multivariate regression analysis, patients who complained of UI "three to four times a day or more" had 6.4-fold higher risk (P=0.027) of perceiving that their symptoms were more severe than those who complained of a UI "one to two times per week or less." Patients with a pad test weight of >25 g had a 4.7-fold higher risk of perceiving their symptoms were more severe than those with a pad test weight of <15 g.

CONCLUSIONS

Our results suggest that the frequency of UI episodes and the volume of urine loss are associated with PPDS. In addition, the I-QoL scores deteriorated significantly as the PPDS of incontinence increased. Thus, PPDS may impact on the QoL of women with stress UI combined with or without urge UI.

Questionnaire survey on female urinary frequency and incontinence

BACKGROUND

Urinary incontinence is a well-known bothersome symptom in women, which may cause physical and psychological problems. We conducted a questionnaire survey on female urinary incontinence to investigate the disease's impact on the quality of life (QoL), the reasons women don't seek medical attention and the information they wished to obtain.

PATIENTS AND METHODS

From March to October 2002, a member of the Professional Women's Coalition for Sexuality and Health distributed a questionnaire about urinary frequency and urinary incontinence to women who were attending the lectures hosted by the group.

RESULTS

We analysed 262 questionnaires: 158 people belonged to the Stress Urinary Incontinence (SUI) Group, 36 to the Overactive Bladder (OAB) Group, 22 to the Urinary Frequency (UF) Group and 18 to the Normal Group. 'Going out' was most influenced in all three groups with symptoms in their daily life. Compared with the Normal or SUI Group, the QoL in those belonging to the OAB and UF Groups was more deteriorated. The medical institution check-up rate in the SUI Group was the lowest at 7.1%, bringing down the overall consultation rate to 13.5%. More than 70% of respondents who didn't have a check-up said that they did not think it was a problem serious enough to require consultation.

CONCLUSIONS

Urinary incontinence and frequency impairs women's QoL. It is important to provide information on these diseases and to provide medical treatments that cater to the needs of individual patients.

The impact of stress urinary incontinence on sexual activity in women

In women, stress urinary incontinence is a common problem that may lead to sexual dysfunction. We review the epidemiological data, the pathophysiology, and the risk factors for these two "closet" disorders, how they are related, how we can get patients to talk about them, and how the treatment of stress urinary incontinence may affect sexual dysfunction.

Comparison of the quality of life after nonsurgical radiofrequency energy tissue micro-remodeling in premenopausal and postmenopausal women with moderate-to-severe stress urinary incontinence

OBJECTIVE

This study was undertaken to determine the effect of menopause and hormone replacement therapy (HRT) on incontinence quality of life (I-QOL) score improvement in women with moderate-to-severe stress urinary incontinence (SUI) after nonsurgical, transurethral radiofrequency energy (RF) tissue micro-remodeling.

STUDY DESIGN

Retrospective review of prospective, randomized, controlled clinical trial. Women with moderate-to-severe SUI were analyzed by menopausal status and HRT use for 10-point or greater I-QOL score improvement (an increase associated with subjective and objective SUI improvement).

RESULTS

RF micro-remodeling resulted in 81% of subjects achieving 10-point or greater I-QOL score improvement versus 49% of sham subjects at 12 months ( P = .04). Outcomes did not differ statistically when premenopausal (85%), postmenopausal using HRT (70%), and postmenopausal not using HRT (71%) groups were compared.

CONCLUSION

Menopausal status and HRT demonstrated no impact on the quality of life improvement experienced by women with moderate-to-severe SUI who underwent RF tissue micro-remodeling.

Self-assessed health, sadness and happiness in relation to the total burden of symptoms from the lower urinary tract

OBJECTIVES

To evaluate the effect of lower urinary tract symptoms (LUTS) on self-assessed health, sadness and happiness of men.

SUBJECTS AND METHODS

The study included 504 men (aged 40-80 years) in the rural community of Surahammar, Sweden, who a year earlier had reported stress incontinence, urgency or postvoid dribbling in answer to a postal questionnaire, and 504 age-matched control men from the same community. The occurrence of 12 specific LUTS was rated using the Danish Prostatic Symptom Score. Health, sadness and happiness were measured by three questions from the Medical Outcomes Study Short-Form 36 health survey questionnaire.

RESULTS

Completed questionnaires were returned by 74.2% of men (748/1008). A low score for health was reported by 34% of men with one to four LUTS, by 67% with five to eight, and by 75% with nine or more LUTS. The total LUTS burden correlated with lower scores for happiness and with higher scores for sadness. For each of the 12 specific LUTS, men with the symptom had lower scores for health and happiness, and higher scores for sadness, than men without the symptom. Comparing men with the symptom of 'other incontinence' to men with no 'other incontinence', the relative risk (95% confidence interval) of impaired health was 2.2 (1.8-2.8), while that of a high score for happiness was 0.5 (0.3-0.7) and that of greater sadness was 2.3 (1.7-3.3). Social status, marital status, education, smoking, physical activity and urinary tract infection all affected the impact of LUTS.

CONCLUSIONS

The total burden of LUTS is related to self-assessed health, sadness and happiness.

Outcome Following TVT Sling Procedure: A Comparison of Outcome Recorded by Surgeons to that Reported by Their Patients at a London District General Hospital

OBJECTIVE

Retrospective study to assess patient satisfaction rates after TVT sling procedure for stress urinary incontinence (SUI), and comparison of these results to the post-operative progress documented by the surgeons in the clinical notes.

METHODS

All TVT sling cases at our institution during February 1999 to December 2002 were included. Data was collected from clinical notes on post-operative outcome as recorded by the surgeons, and a patient satisfaction questionnaire was used to assess patients' perception of their progress.

RESULTS

The response rate to the patient satisfaction questionnaire was 72%. Overall 94% of the patients were satisfied with the procedure. However, they reported cure rates of only 44%. This is comparable to the 46% cure rates documented by the surgeons.

CONCLUSION

The surgeons' and the patients' perceptions regarding outcome and change in symptoms after TVT sling for SUI at our hospital, correlate well. Hence, the documentation in the clinical notes by the surgeons can be relied upon as an accurate representation of post-operative patient progress. Despite the relatively low cure rates (44-46%) for SUI with TVT sling procedure, the patient satisfaction rates with the outcome are high (94%), reiterating that there is a poor correlation between quality of life impairment and the concept of cure.

Cadaveric prolapse repair with sling: intermediate outcomes with 6 months to 5 years of followup

PURPOSE

We present the prospective, intermediate-term results for cadaveric prolapse repair with sling as combined treatment of stress urinary incontinence and cystocele.

MATERIALS AND METHODS

A total of 251 of 295 (85%) patients undergoing cadaveric prolapse repair with sling (CaPS) had at least 6 months of questionnaire and pelvic examination followup. All patients had objectively demonstrated stress urinary incontinence and grade 2 to 4 cystocele before surgery. Followup outcome measures included a validated subjective continence and patient satisfaction questionnaire, SEAPI (stress incontinence, emptying, anatomy, protection, inhibition) scores, pelvic examination for prolapse recurrence and complications, and quality of life scores.

RESULTS

The overall patient reported subjective incontinence cured/dry rate (no incontinence episodes of any type) was 114 of 251 (45%), the cured/improved rate (50% improvement or greater) was 192 of 251 (76%) and the failed rate (less than 50% improvement) was 59 of 251 (24%). When considering stress urinary incontinence the cured/dry rate was 141 of 251 (56%), cured/improved rate was 207 of 251 (82%) and failed rate was 44 of 251 (17.5%), with 17 of the 44 (39%) cases having mixed urinary incontinence. Of the 59 failures 33 (56%) occurred after 12 months of followup. Of 153 patients 13 (8.5%) experienced de novo urge incontinence. The symptomatic cystocele recurrence rate was 18 of 251 (7%). There were statistically significant improvements in SEAPI and prolapse quality of life scores. Of 251 patients 200 (80%) were at least 50% satisfied and of 251 193 (77%) stated they would undergo the CaPS procedure again.

CONCLUSIONS

With a maximum followup of 5 years in patients undergoing CaPS, we have seen excellent, durable cystocele repair results. While our subjective continence rates have decreased with an increasing number of late failures, we continue to observe significant improvement in SEAPI scores and quality of life with good patient satisfaction and low morbidity.

Pr�valenz der Urininkontinenz in der deutschen Bev�lkerung

The purpose of this study was to determine the frequency of incontinence in men and women in different age groups. In a representative survey, 883 men and 1,182 women with a mean age of 50 years (18-92 years) were studied based on standardized questionnaires on physical and psychological complaints, and quality of life. Participants suffering from involuntary loss of urine were considered "incontinent". The frequency of incontinence strongly increased with age, from 6.9% among the 18-40 year old population to 9.5% among the 41-60 year olds and 23% over the age of 60 years. Women complained more frequently of incontinence (15%) than men (9.5%; total of 12.6% in the population). The majority of the participants with incontinence also suffered from urinary urge, multiple disorders of digestion, pelvic pain and sexual dysfunction. There was also a strong increase in exhaustion, gastric pain, joint pain and cardiac complaints. The younger participants were more strongly affected by incontinence. When patients complain of incontinence, strong impairments in physical and psychological well-being, and quality of life are to be expected.

Psychometric properties and validation of the German-language King's Health Questionnaire in women with stress urinary incontinence

AIMS

The purpose of this study was to evaluate the psychometric properties of and validate the German-language version of the King's Health Questionnaire (KHQ) in women with stress urinary incontinence (SUI).

METHODS

A total of 145 women treated for stress incontinence with surgery or physiotherapy completed the the KHQ and the SF-36 before and after treatment. Psychometric analyses of the quality of life (QoL) instruments determined the reliability (Cronbach's alpha), internal and external validity, and responsiveness of the KHQ subscales.

RESULTS

The KHQ showed good internal consistency, content validity, and criterion validity as measured by correlation with scores on the SF-36. Cronbach's alpha coefficient ranged from 0.76 to 0.86, indicating a high internal consistency of the subscales. Concerning criterion validity, correlations between the KHQ subscales and the SF-36 were low to moderate. The highest correlation was found between the general health perception subscales of both questionnaires.

CONCLUSIONS

The results indicate good psychometric properties for the German-language KHQ.

Paula method of circular muscle exercises for urinary stress incontinence—a clinical trial

The aim of this study was to determine the efficacy of the Paula method of circular muscle training in the management of stress incontinence (SI). The theory behind this method states that activity of distant sphincters affects other muscles. In a pilot study, 59 women, mainly hospital employees, were randomly assigned to participate in exercises according to the Paula method or pelvic floor training. Efficacy was measured by reports of incontinence, quality of life (I-QOL), pad test, and pelvic floor muscle strength (assessed by perineometer and digital examination). Both the Paula exercises and pelvic floor training produced significant changes in urinary leakage compared to baseline as measured by the pad test [mean decrease of 5.4 g (p=0.002) and 9.5 g (p=0.003), respectively]. Women randomized to the Paula method reported improvement in I-QOL scores. The Paula method was found to be efficacious for SI in a population of Israeli women. Larger community-based studies will be required to confirm these results and enable evaluation of between-group differences.

Stress urinary incontinence in the gynecological practice

This review discusses the prevalence, risk factors, the impact on the quality of life and healthcare-seeking behavior of women suffering from urinary incontinence (UI) and stress urinary incontinence (SUI) in particular. UI is a common problem, affecting women in all age groups, and has devastating effects on their social, professional and family life. UI may be manifest as stress urinary continence (SUI), i.e. 'the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing'. SUI is the most common form of UI, reported by approximately 50% of the incontinent women. Alternatively, patients may suffer from urge urinary incontinence (UUI), characterized by the 'complaint of involuntary leakage accompanied or immediately preceded by urgency'. This is reported by 10-20% of incontinent women. Patients having symptoms of both disorders may be afflicted by mixed urine incontinence (MUI), being reported by 30-40% of incontinent women. This complaint was recently included in the definitions as: 'Involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing'. Urodynamic studies show that the prevalence of SUI is underestimated when based on symptoms alone, as many patients with mixed symptoms have pure SUI during urodynamics. Although the etiology of SUI is still poorly understood, among the main risk factors are age, pregnancy, childbirth and obesity. Unfortunately, the majority of the patients suffering UI postpones looking for medical help for years, or may even never consult a physician regarding their problem, despite the considerable negative impact on their quality of life. Feelings of shame and embarrassment play an important role in this, in combination with the common belief that UI is a normal and inevitable consequence of the aging process. Clearly, there is still a long way to go in making patients and society aware of the fact that UI is a disorder, which can and should be treated. Consequently, patients must be encouraged to report their problem, while health care providers should raise the issue on routine exams in risk groups.

The relationship between clinical parameters and health-related quality of life as measured by the 15D in incontinent women before and after treatment

BACKGROUND

The purpose of this study was to correlate the clinical parameters with a health-related quality of life (HRQoL) measure and to describe the change of HRQoL caused by treatment and its modifying factors among urinary incontinent women.

METHODS

Eighty-two incontinent women, referred to a tertiary gynecologic department, underwent clinical evaluation to establish diagnosis and severity of urinary incontinence (UI) and completed the generic 15D HRQoL instrument. Sixty-nine women were re-evaluated 13 months after treatment.

RESULTS

Compared to age-matched female general population, the HRQoL of urinary incontinent women was significantly lower. Urge or mixed incontinence impairs HRQoL more than stress incontinence. The 15D scores correlated poorly with urodynamics, frequency/volume chart findings, and the amount of urine leakage. Among patients with stress UI (SUI), the HRQoL after treatment was the same as in the age-matched general female population. Among women with urge or mixed UI, the HRQoL improved significantly after treatment but did not reach the HRQoL level of women with SUI at baseline. In stepwise regression analysis, lower the 15D score at baseline and bigger the decrease in urine leakage, greater was the change in HRQoL for the better.

CONCLUSION

There was a modest correlation of incontinence severity measures with quality of life impairment. The challenge for the future will be to improve the success of treatment for women with urge UI. The generic 15D appears to be sensitive to detect change in HRQoL due to treatment of UI women.

Tension-free vaginal tape: a prospective subjective and objective outcome analysis

The purpose of this prospective study was to describe the effects of the tension-free vaginal tape (TVT) procedure on subjective and objective outcomes. Eighty-seven women (aged 31-95 years) underwent a TVT procedure and were followed for up to 24 months using the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and a Patient Satisfaction Questionnaire. IIQ-7 scores improved from a mean 51.1 before surgery to 12.7 at 1 month (p<0.001) indicating reduced impact of incontinence on quality of life. UDI-6 scores declined from a mean 61.8 to 21.9 (p<0.001) indicating improvement in urinary symptoms. At 1 month, 91.2% of patients were satisfied. Improvements on all measures were maintained throughout follow-up. Urodynamic evaluation of 57 patients (mean: 15.0 months) showed that 91.2% had a negative stress test. Results indicate significant immediate and sustained improvement in incontinence impact and urinary symptoms, and a high rate of patient satisfaction and objective cure.

The costs of stress urinary incontinence

SUI affects individuals' quality of life. It also has resource implications for individuals, health services and society in general. Quantification of these costs can aid decision making by illustrating the size of the problem and identifying conditions and groups for whom large costs are incurred. However, comparatively little is known about these costs as few costing studies have been carried out in the UK and no studies have identified costs by types of urinary incontinence.

Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: A randomized, placebo-controlled trial

OBJECTIVES

To examine the efficacy and tolerability of antimuscarinic therapy in women with urge-predominant mixed incontinence.

METHODS

This was a double-blind, randomized, placebo-controlled trial comprising 854 women with urge-predominant mixed incontinence, including urge incontinence (five or more episodes per week), urinary frequency (eight or more micturitions on average in 24 hours), and urgency in combination with stress incontinence. Women received 8 weeks of treatment with tolterodine tartrate extended-release (ER) 4 mg or placebo once daily. The outcome measures included urge incontinence episodes per week, stress incontinence episodes per week, micturition frequency per 24 hours, urgency episodes per 24 hours, volume voided per micturition, patient perception of bladder condition, and assessment of treatment benefit.

RESULTS

After 8 weeks, tolterodine ER produced a statistically significant decrease in the weekly urge incontinence episodes compared with placebo (-12.3 versus -8.0; P <0.0001). Other micturition variables improved significantly more with tolterodine ER. No difference was found between treatment groups regarding the change in the number of stress incontinence episodes. A significantly greater proportion of patients receiving tolterodine ER than those receiving placebo reported improvement in bladder condition (61% versus 46%; P <0.001) and treatment benefit (76% versus 55%; P <0.001). After 8 weeks, the tolterodine ER group had experienced statistically significant improvements compared with the placebo group in 9 of 10 quality-of-life domains. The frequency of adverse events was similar between treatment groups.

CONCLUSIONS

Tolterodine ER is an effective treatment of urge urinary incontinence, frequency, and urgency in women with concomitant stress urinary incontinence. The efficacy of tolterodine ER in reducing urge incontinence episodes was unaffected by the presence of stress incontinence. The results of this study support the first-line use of antimuscarinic therapy to treat the urge incontinence component of urge-predominant mixed incontinence.

Late urologic effects after adjuvant irradiation in stage I endometrial carcinoma

OBJECTIVES

To evaluate the incidence and type of incontinence after external beam radiotherapy (RT) and brachytherapy. Distinct late effects on the urinary bladder can occur and are frequently mild after adjuvant RT for Stage I endometrial carcinoma. Not all side effects that impair quality of life (eg, urinary incontinence) are classified in the commonly used grading system.

METHODS

Forty-one patients were evaluated for newly occurred urinary incontinence after adjuvant RT. The mean follow-up was 64.8 months, and the mean age was 62.1 years. The validated incontinence score from Gaudenz was used. Additionally, quality-of-life questions were asked.

RESULTS

Overall, 22 (53.7%) of 41 patients complained of urinary incontinence. Urge incontinence was classified in 45.5% (10 of 22 patients) and stress urinary incontinence in 54.5% (12 of 22 patients).

CONCLUSIONS

The onset of stress urinary incontinence after brachytherapy can be explained by anatomic findings, such as adverse affects to the nerve supply of the rhabdosphincter. According to our results, the exposure to additional external beam RT can cause urge incontinence. Patients and doctors must be aware that urinary incontinence, with an occurrence rate of more than 50%, represents the most common side effect after surgery and RT for Stage I endometrial carcinoma. We conclude that, depending on the type of RT, a stress incontinence rate of 24.4% and an urge incontinence rate of 29.2% is possible.

Reliability, validity, and gender differences in the quality of life index of the SEAPI-QMM incontinence classification system

PURPOSE

To evaluate reliability and validity of the SEAPI-QMM 15-item quality of life index and assess differences between male and female patients with urinary incontinence.

MATERIALS AND METHODS

Twice pre- and once post-treatment, 315 patients (102 men, 213 women) with incontinence and 35 without incontinence completed the self-directed SEAPI-QMM quality of life index. A voiding diary reported frequency of incontinence episodes with number of pads or type of protection used daily for incontinence. In 30%, the Nottingham Health Profile (NHP) was administered to further validate the measure.

RESULTS

Cronbach's alpha coefficient for the index was 0.91. Domain-specific alpha coefficients ranged from 0.88 to 0.73. Test-retest reliability scores at 5 days gave a reliability coefficient of 0.93. Split half reliability was 0.89. Correlation of the index with the NHP was 0.78 for women, 0.72 for men. Mean scores before and after treatment with medical or surgical management were significantly different in both genders and were sensitive to the presence or absence of use of protection and the type of protection chosen in men. Men with incontinence (61%) reported a high level of impact in the sexuality domain compared to 7% of women.

CONCLUSIONS

The SEAPI quality of life index has a high degree of reliability relating to stability and internal consistency across a wide age range in both genders. There are differences between men and women in life domains most frequently affected by urinary incontinence.

Assessing comfort, safety, and patient satisfaction with three commonly used penile compression devices

OBJECTIVES

To assess the safety, efficacy, comfort, and patient satisfaction with three penile compression devices: the Cunningham clamp, C3, and U-Tex.

METHODS

The devices were tested in random order in a multiple-period, crossover study design using a Latin squares configuration. The subjects had undergone radical prostatectomy 6 months or more before the study, had no neurologic or cognitive impairment, and had not undergone radiotherapy. Baseline penile Doppler ultrasonography was followed by ultrasound scanning with each device. In random order, subjects completed a 4-hour pad test, with and without each device, and the questionnaire.

RESULTS

Twelve men completed the study. The mean Mini-Mental State Examination score was 29.6 (SD 1.2, range 27 to 30). The mean urine loss at baseline was 122.8 g (SD 130.8). The mean urine loss with each device was 53.3 g (SD 65.7) with the U-Tex, 32.3 g (SD 24.3) with C3, and 17.1 g (SD 21.3) with the Cunningham clamp (P <0.05). No device had an impact on the resistive index; the C3 and U-Tex allowed good cavernosal artery flow, and the Cunningham clamp significantly lowered the distal blood flow velocity (from 12.5 to 7.3 cm/s [left systolic velocity] to 9.5 cm/s [right systolic velocity]) even at the loosest setting. The Cunningham clamp was ranked positively by 10 of 12 men; 2 of 12 men rated the C3 positively; none rated the U-Tex positively.

CONCLUSIONS

The Cunningham device was the most efficacious and most acceptable to users, but also contributed to reduced systolic velocity in all men. None of the devices completely eliminated urine loss when applied at a comfortable pressure. Individualized instruction to cognitively capable men is necessary to ensure appropriate application, comfort, and fit.

The effect of tension-free vaginal tape (TVT) procedure on sexual function in women with stress urinary incontinence

The aim of this study was to evaluate the effects of tension-free vaginal tape (TVT) on sexual function in women with stress urinary incontinence (SUI) by questionnaire. Thirty-two sexually active and married women who were planned for TVT to treat SUI constituted the patient group, and 25 women who were healthy, sexually active and married, were selected as the control group; the ages of both groups matched. Sexual functions (desire, arousal, orgasm, pain and satisfaction) were evaluated with the Index of Female Sexual Function (IFSF), and continence status during sexual intercourse was asked about both preoperatively and postoperatively in the 6th month. The mean domain scores of sexual functions such as desire, arousal, orgasm, pain and overall satisfaction preoperatively and postoperatively were 3.37+/-0.69, 3.82+/-0.62, 3.40+/-0.95, 3.41+/-0.98, 3.16+/-1.09 and 3.32+/-0.79, 3.71+/-0.53, 3.06+/-1.04, 2.75+/-1.29, 2.88+/-0.63, respectively, and postoperative scores insignificantly decreased. Also, these scores in the control group were 3.64+/-0.66, 3.96+/-0.73, 4.12+/-0.78, 3.96+/-1.14 and 3.68+/-0.92. In comparison with the control group, whereas all of the preoperative domain scores were found to be decreased but were statistically insignificant except orgasmic function, postoperative scores significantly worsened, except for desire and arousal. However, preoperatively nine patients explained that they had incontinence during sexual intercourse, and this problem persisted in two postoperatively ( p = 0.043). This study shows that both SUI and the TVT procedure negatively affect sexual function in women.

Burden of stress urinary incontinence for community-dwelling women

OBJECTIVE

The purpose of this study was to better understand the subjective bothersomeness of stress urinary incontinence symptoms and their impact on the quality of life of community-dwelling women.

STUDY DESIGN

We conducted a mail survey of 605 women in the United States who reported symptoms of stress urinary incontinence.

RESULTS

More than three fourths of the respondents reported their symptoms to be bothersome, with approximately 29% reporting their symptoms to be moderately to extremely bothersome. The odds of moderate-to-extreme bother decreased with age and increased with symptom severity. Concerns about social embarrassment were evident.

CONCLUSION

Stress urinary incontinence symptoms can impose a significant burden on the women who have them. The results reinforce the need for health care professionals to be proactive in questioning and educating patients about this common lower urinary tract symptom.

The development of a national database of the results of surgery for urinary incontinence in women

OBJECTIVE

To describe the development of a national network, database and reporting of data from a short-form questionnaire recording the severity of symptoms, quality of life and objective outcome values pre- and post-operatively, in women with stress and mixed incontinence.

DESIGN

A prospective descriptive study.

SETTING

Twenty-three Norwegian departments of gynaecology.

PARTICIPANTS

Eight hundred and eighty-three women with stress and mixed incontinence.

METHODS

A short-form questionnaire was used to record the severity of symptoms, quality of life and objective outcome values pre- and post-operatively, in women with stress and mixed incontinence. Type of operation, the performance of a combined vaginal prolapse operation and an incontinence procedure and complications were recorded. The questionnaires were scanned and data were transferred to a national database. Twice a year the participating departments received a report where their own data were compared with the national average.

MAIN OUTCOME MEASURES

Pre- and post-operative Stress, Urge and Quality of Life Indices, Satisfactioin with the operation. Post-operative mean Stress, Urge and Quality of Life Indices, leakage during stress test, and satisfaction with the operation, related to number of operations performed by each surgeon.

RESULTS

Eighty-four percent of the operations performed were with the tension-free vaginal tape operation and 13% were abdominal Burch colposuspensions. The post-operative Stress and Urge Incontinence Indices and Quality of Life Index and all the objective outcome values except for the mean voiding volume were significantly lower than they were pre-operatively. Eighty-four percent of the women were very satisfied, 8% were moderately satisfied, 2% were neither satisfied nor dissatisfied, 3% were moderately dissatisfied and 2% were very dissatisfied with the operation. Women who had a tension-free vaginal tape operation performed were significantly more satisfied, were leaking significantly less, had significantly lower stress incontinence and quality of life indices and had significantly less superficial infections post-operatively than women who had had a Burch colposuspension. Surgeons performing fewer than 25 operations had a large variation in their results.

CONCLUSION

A large number of Norwegian gynaecological departments are reporting to the database. The questionnaire and the objective outcome values are well suited to record the effect of incontinence operations and to make comparisons between surgical procedures, surgeons and departments.

The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence

OBJECTIVES

To develop and validate a short questionnaire recording the severity of symptoms and the quality of life, pre- and post-operatively, in women undergoing surgery for stress incontinence.

DESIGN

The questionnaire was designed from previously designed questionnaires and pilot studies. In this study, it was tested for validity and reliability using standard psychometric techniques. Data from the questionnaire are reported to a national database, which generates reports for comparison of surgical procedures, departments and surgeons.

SETTING

Tertiary referral urogynaecology units at Baerum and Aker Hospitals, Norway, and 22 Norwegian departments of gynaecology.

POPULATION

Fifty and 65 women with stress incontinence from Baerum and Aker hospitals, respectively, and 628 women with stress incontinence from 22 Norwegian departments of gynaecology.

METHODS

Stress Incontinence, Urge Incontinence and Quality of Life Indices were constructed. Internal consistency of the indices was measured by Cronbach's alpha and test-retest reliability by Bland-Altman plots. Stress Incontinence Index was tested against stress test and Urge Incontinence Index and Stress Incontinence Index were tested against the 24-hour pad test. Quality of Life Index was tested against a part of the King's College Hospital Quality of Life Questionnaire.

MAIN OUTCOME MEASURES

Face and content validity. Missing values of the questionnaire. Reliability and internal consistency. Criterion validity.

RESULTS

The 628 women completed a mean of 98.2% of all the questions. The content validity was good. The reliability was good in terms of test-retest reliability and internal consistency. The criterion validity of stress and urge incontinence was tested against the stress and 24 hour pad tests. The correlation between the indices and the objective tests was moderate. The correlation between the Quality of Life Index and the physical and social part of the previously validated King's College Hospital questionnaire was good.

CONCLUSIONS

The questionnaire is easy to understand and complete and is a valid and reliable instrument for assessment of the symptoms of incontinence and the quality of life. Pre- and post-operative evaluation of women with stress incontinence was performed in a standardised setting in 22 of the 37 Norwegian departments and the reporting to a national database was successful. Comparison of surgical procedures, departments and surgeons is possible.

An assessment of the importance of pad testing in stress urinary incontinence and the effects of incontinence on the life quality of women

Our objectives in this study were to determine the severity of incontinence using pad testing and the effects of incontinence on the life quality of women with stress incontinence. Fifty women with a diagnosis of stress urinary incontinence were selected for the study. The Symptom Severity Index (SSI) and Symptom Impact Index (SII) were used to determine the severity and impact of incontinence. Afterwards the women were given a 1-h pad test. According to the pad tests 38% of women suffered severe to very severe incontinence. Women who showed severe incontinence on pad testing scored high in the SSI; on the other hand, no relationship was found between SII and pad test indicators. It was also observed that both SSI and SII scores increased with increasing age of the women (SSI: r=0.29, P<0.05; SII: r=0.30 P<0.05). It may therefore be concluded that the severity of incontinence makes no difference in the effects of incontinence on the life quality of women.