An updated review of quality-of-life questionnaires for urinary incontinence and overactive bladder: Which ones to use and why

The effect of duloxetine on female sexual functions in the treatment of stress incontinence

OBJECTIVES

Stress urinary incontinence (SUI) is defined as urinary incontinence that occurs with coughing, sneezing, and physical exercise. It is frequently observed in women after middle age and has a negative impact on their sexual function. Duloxetine as one of the Serotonin-noradrenaline reuptake inhibitors (SNRIs) is commonly used in the non-surgical treatment of SUI. The aim of our study is to investigate the effect of duloxetine, which is used in the treatment of SUI, on sexual functions in female patients.

METHODS

The study included 40 sexually active patients who received duloxetine 40 mg twice a day for the treatment of SUI. All patients had female sexual function index (FSFI), Beck's depression inventory (BDI), and incontinence quality of life score (I-QOL) applied before and 2 months after starting duloxetine treatment.

RESULTS

FSFI total score significantly increased from 19.9 to 25.7 (p < 0.001). In addition, significant improvement was observed in all sub-parameters of FSFI, including arousal, lubrication, orgasm, satisfaction, and pain/discomfort (p < 0.001, for each FSFI subtotal score). BDI significantly decreased from 4.5 to 1.5 (p < 0.001). I-QOL score significantly increased from 57.6 to 92.7 after the duloxetine treatment.

CONCLUSIONS

Although SNRIs carry a high risk of sexual dysfunction, duloxetine may have an indirect positive effect on female sexual activity, both through its stress incontinence treatment and its antidepressant effect. In our study, Duloxetine, one of the treatment options for stress urinary incontinence and an SNRI, has a positive effect on stress urinary incontinence, mental health, and sexual activity in patients with SUI.

Bladder and bowel symptoms following imprisonment in West Australian female prisons

PURPOSE

The purpose of this paper is to investigate the presence of bladder and bowel symptoms in women recently imprisoned in Western Australian prisons, specifically; stress, urge and mixed urinary incontinence, faecal incontinence, nocturia, nocturnal enuresis and constipation and the impact on the quality of life (QOL).

DESIGN/METHODOLOGY/APPROACH

Over a 12-month period 29 women, recently released from Western Australia's female prisons, were surveyed using a questionnaire previously validated for the prison population. The Short Form King's Health Questionnaire and a modified version of the Manchester Health Questionnaire were used to assess the effects of these symptoms on QOL.

FINDINGS

Of those surveyed only one respondent reported having no bladder or bowel symptoms following release from prison. Trends assessed by Chi-square analysis suggest women imprisoned for any period of time are more likely to develop both bladder and bowel symptoms which persist after release back into the community. A history of substance or alcohol abuse is often concurrent with the presence of symptoms. QOL scores are also lower for those reporting either bladder or bowel symptoms affecting total scores and the domains of both activities of daily living and mental health.

ORIGINALITY/VALUE

Women imprisoned for any length of time developed bladder and bowel symptoms which had a negative impact on their QOL. Larger studies need to be conducted to investigate these trends and whether small changes in conservative measures can influence outcomes.

Impact of overactive bladder on quality of life and resource use: results from Korean Burden of Incontinence Study (KOBIS)

Background

To evaluate the impact of overactive bladder (OAB) on quality of life (QOL), resource use and productivity loss in patients recruited from six hospitals in Korea.

Methods

This cross-sectional survey recruited 625 OAB patients between July to December 2013. Patients were categorised into four groups based on the average number of urinary incontinence (UI) episodes over the past three days (0, 1, 2–3 and ≥4 UI/day). QOL was measured using the Incontinence-Specific Quality of Life Instrument (I-QOL), the Overactive Bladder Questionnaire (OAB-q), and a generic health-related utility instrument (EQ-5D). Information on hospital and clinic visit frequency, and continence pads use were also collected. Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Between group differences were assessed using ANOVA. Multivariable regression analyses were performed to examine the independent effects of OAB symptoms on QOL.

Results

Severity of UI showed a significant linear relationship with QOL, with clinically meaningful differences between each UI severity category. Compared to the dry category, patients in the most severe category (≥4 UI/day) had significantly lower I-QOL scores (69.8 vs 42.6; p < 0.0001), greater symptom bother on the OAB-q (30.4 vs 64.6; p < 0.0001), and poorer EQ-5D utility (0.848 vs 0.742; p < 0.001). Multivariable analyses showed that UI severity, frequency, urgency, and nocturia are independently associated with poorer QOL. Incontinence severity is also significantly associated with cost of incontinence pads (p < 0.0001), and a greater interference with work and regular activities (p = 0.001), however, no significant difference in hospital and clinic visits were observed.

Conclusion

Severity of UI is a key contributor to the disease burden of OAB in Korean patients, even after taking into account the impact of other symptoms associated with OAB.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-015-0274-9) contains supplementary material, which is available to authorized users.

Mapping of incontinence quality of life (I-QOL) scores to assessment of quality of life 8D (AQoL-8D) utilities in patients with idiopathic overactive bladder

Background

The Incontinence Quality of Life (I-QOL) questionnaire is a commonly used and validated incontinence specific QOL instrument. The objective of this study is to develop an algorithm to map I-QOL to the Assessment of Quality of Life (AQoL) 8D utility instrument in patients with idiopathic overactive bladder (iOAB).

Methods

I-QOL and AQoL-8D scores were collected in a survey of 177 Australian adults with urinary incontinence due to iOAB. Three statistical methods were used for estimation, namely ordinary least squares (OLS) regression, the robust MM-estimator, and the generalised linear models (GLM). Each included a range of explanatory variables. Model performance was assessed using key goodness-of-fit measures in the validation dataset.

Results

The I-QOL total score and AQoL-8D utility scores were positively correlated (r = 0.50, p < 0.0001). Similarly, the three sub-scales of the I-QOL were correlated with the eight dimensions and two super-dimensions of the AQoL-8D. The GLM estimator, with I-QOL total score as the explanatory variable exhibited the best precision (MAE = 0.15 and RMSE = 0.18) with a mapping function given by AQoL-8D = exp(−1.28666 + 1.011072*I-QOL/100).

Conclusions

The mapping algorithm developed in this study allows the derivation of AQoL-8D utilities from I-QOL scores. The algorithm allows the calculation of preference-based QOL scores for use in cost-utility analyses to assess the impact of interventions in urinary incontinence.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-014-0133-0) contains supplementary material, which is available to authorized users.

Effects of tolterodine extended release on patient perception of bladder condition and overactive bladder symptoms*

OBJECTIVE

To evaluate the efficacy of tolterodine extended release (ER) versus placebo at 1 and 12 weeks using questionnaires and diary measures.

RESEARCH DESIGN AND METHODS

Subjects with overactive bladder (OAB) were randomized to receive tolterodine ER (4 mg) or placebo for 12 weeks. This double-blind study is registered with ClinicalTrials.gov (identifier: NCT00143377).

MAIN OUTCOME MEASURES

Subjects completed the Patient Perception of Bladder Condition (PPBC) and 3-day bladder diaries at baseline and weeks 1 and 12, and the Overactive Bladder Questionnaire (OAB-q) at baseline and week 12. PPBC score changes were analyzed using 2-category (improvement, no improvement), 3-category (improvement, no change, deterioration), and 4-category (>or=2-point improvement, 1-point improvement, no change, deterioration) stratifications. Categorical change in PPBC scores from baseline to week 12 was the primary endpoint.

RESULTS

A total of 617 subjects were randomized (tolterodine ER, n = 410; placebo, n = 207). At week 1, a significantly higher percentage of subjects receiving tolterodine ER reported improvement on the PPBC compared with placebo (p < 0.05). Subjects receiving tolterodine ER also had a significantly greater reduction in all OAB symptoms versus placebo (all p < 0.05). At week 12, a higher percentage of tolterodine ER subjects reported PPBC improvement versus placebo subjects. This was significant in the 3- and 4-category analyses (both p < 0.05) but not in the 2-category analysis (the prespecified method of analysis; p = 0.098). Compared with the placebo group, the tolterodine ER group reported significantly greater week 12 improvements in all bladder diary variables (all p < 0.01) as well as in OAB-q Symptom Bother, total Health-Related Quality of Life, Coping, and Concern scores (all p <or= 0.02).

CONCLUSIONS

Compared with placebo, subjects receiving tolterodine ER reported significantly greater improvements in nondiary patient-reported outcomes and OAB symptoms at week 12. Improvements in subjects' perception of their bladder-related problems and in OAB symptoms were observed as early as week 1. Further research is required to assess which aspects of subjects' bladder-related problems were improved. A large placebo effect may have prevented the prespecified 2-category analysis of PPBC improvement from reaching statistical significance at week 12, which was the primary endpoint.