Impact of urodynamic based incontinence diagnosis on quality of life in women

Urinary incontinence in middle-aged and older Korean women and its impact on quality of life: a cross-sectional study

PURPOSE

There is a distinct lack of studies on the impact of urinary incontinence on quality of life in middle-aged and older Korean women, despite numerous clinical observations supporting its negative influence. The association between urinary incontinence and quality of life and subjective health state was investigated with various covariates to identify mediating variables.

METHODS

A nationally representative sample of Korean women aged ≥ 45 years (n = 4020) with data for urinary incontinence, quality of life, health-related items and covariates from the 4th Korean Longitudinal Study of Ageing (KLoSA, 2012) were analyzed in a cross-sectional study. Association between urinary incontinence and quality of life and subjective health state adjusted for using sociodemographic factors and health behavior, and regression analysis in adjusted complex sampling design to determine regression coefficients with 95% confidence intervals.

RESULTS

Prevalence of urinary incontinence in middle-aged and older Korean women was 27.5% (n = 1107). The negative relationship between urinary incontinence and quality of life was maintained in full adjustments (sociodemographic factors, health behavior, somatic health, and mental health) with mental health exerting greatest influence on the association between urinary incontinence and quality of life. Moreover, in presence of urinary incontinence symptoms, aggravation of urinary incontinence symptoms held a more negative relationship with quality of life compared to similarly maintained state.

CONCLUSIONS

Urinary incontinence has a negative association with quality of life and subjective health state, and psychological factors which are implicated in old age may be of importance in urinary incontinence patient management.

Urinary incontinence, related factors and menopause-related quality of life in mid-aged women assessed with the Cervantes Scale

OBJECTIVE

To determine urinary incontinence (UI) prevalence, related factors and menopause-related quality of life (QoL) in mid-aged Colombian women.

METHODS

A total of 1739 women aged 40-59 were surveyed with the 31 item Cervantes Scale (CS) and a socio-demographic questionnaire. Item 18 of the scale was used to categorize the degree of UI. Remaining 30 items (Adjusted global score) were used to assess global menopause-related QoL.

RESULTS

Median age of the sample was 46 years. A 26.0% of women presented some degree of UI, rated as moderate to severe in 16.4% of cases. Adjusted global CS scores (excluding item 18) significantly increased with the severity of UI. Mean scores for item 18 were found to be significantly higher in relation to age, menopausal status, body mass index values, lower education and unemployment status. Multiple linear regression analysis determined that age, postmenopausal status and ethnicity (Mestizo) were significantly related to higher item 18 scores, and thus more severe UI.

CONCLUSION

This is the first study to report UI prevalence in a large mid-aged Latin American female population in which age, menopausal status and ethnicity were related factors.

Longitudinal trends with improvement in quality of life after TVT, TVT O and Burch colposuspension procedures

BACKGROUND

Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes.

MATERIAL/METHODS

The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period.

RESULTS

The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (p<0.001). Only the OAB complication had a statistically significant effect on QoL p<0.001. Preexistent OAB does not negatively affect postoperative results of anti-incontinence surgery.

CONCLUSIONS

There was a statistically significant decline with the longitudinal values of IQOL with TVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable.

The correlations of incontinence-related quality of life measures with symptom severity and pathophysiology in women with primary stress urinary incontinence

PURPOSE

We sought to explore the correlations of incontinence-related quality of life (QoL) measures with the symptom severity and pathophysiological factors for female stress urinary incontinence (SUI).

METHODS

We retrospectively reviewed the records of 707 women who had primary SUI. Clinical data for analysis included Ingelman-Sundberg scales, 1-h pad tests, incontinence-related QoL questionnaires comprising short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), ultrasound assessment of urethral support and urethral sphincter function determined by maximum urethral closure pressure and Valsalva leak point pressure. The correlations of incontinence-related QoL, measured by UDI-6 and IIQ-7 questionnaires, with the independent variables such as Ingelman-Sundberg scales, 1-h pad tests, urethral support and urethral sphincter function were investigated.

RESULTS

The scores of item 3 of UDI-6 as well as the sum scores of UDI-6 and IIQ-7 had significant correlation with incontinence severity assessed by Ingelman-Sundberg scales and 1-h pad tests. However, only the scores of item 3 of UDI-6 were significantly correlated with the presence of bladder neck funneling on ultrasound and maximum urethral closure pressure. No correlations exist between sum scores of UDI-6 or IIQ-7 and the pathophysiological factors of SUI.

CONCLUSIONS

Urogenital Distress Inventory-6 and IIQ-7 play important and complementary roles in comprehensive assessment for SUI, but are not identical to the pathophysiological factors.

Is it possible to diagnose intrinsic sphincter deficiency in women?

PURPOSE OF REVIEW

The diagnosis of intrinsic sphincter deficiency became important about 20 years ago when it influenced the choice of operative procedure for women with stress urinary incontinence. However, it was ill-defined and diagnosed by a variety of techniques. The contemporary surgical treatment of urinary stress incontinence is by suburethral sling; so this review addresses three questions: is it still important to identify intrinsic sphincter deficiency prior to surgical intervention for stress incontinence? What techniques are available to do so? How robust are these measurements?

RECENT FINDINGS

There is some evidence that women with intrinsic sphincter deficiency have a poorer outcome if they are treated by a transobturator tape compared with a tension-free vaginal tape or a pubovaginal sling. Intrinsic sphincter deficiency continues to be mainly identified by low urethral closure pressures or low abdominal leak point pressures or both but the methodology is variable. There have been some attempts at using ultrasound to identify intrinsic sphincter deficiency but without any definite conclusions.

SUMMARY

Intrinsic sphincter deficiency is an imprecise diagnosis, which continues to be defined by a low pressure urethra. This can be measured in different ways but there is poor standardization of the tests to do so. Intrinsic sphincter deficiency appears to be clinically important but the full implications of this diagnosis will remain unknown until this imprecision is addressed.