The predictive value of ePAQ in the urodynamic diagnoses-A prospective cohort study

AIMS

To assess whether the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) had accuracy in predicting the urodynamic diagnoses of Detrusor Overactivity (DO) and/or Urodynamic Stress Incontinence (USI).

METHODS

Tertiary urogynaecology unit linked to an academic university teaching hospital. Consecutive women who presented with lower urinary tract symptoms (LUTS) and were booked to have urodynamic studies. Women completed an ePAQ-PF prior to having urodynamics (UDS) by clinicians who were blinded to the ePAQ-PF results while conducting this procedure. Receiver Operating Characteristics (ROC) curves were constructed for predictive accuracy of overactive bladder (OAB) score in DO and of stress urinary incontinence (SUI) score in USI. Prospective cohort study designed to meet the requirements of the standards for reporting of diagnostic accuracy (STARD).

RESULTS

390 women with a mean age of 54.2 (range 21-92) years were recruited. The majority (n = 294; 75%) were White Caucasian and had two children (n = 157; 40.3%). Of them, 67.2% (n = 262) had DO and USI was confirmed in 21.5% (n = 84). The area under the ROC curve for DO was 0.704 (95% confidence interval 0.650-0.759) and for USI it was 0.731 (95% confidence interval 0.652-0.778).

CONCLUSIONS

The OAB and SUI scores on the ePAQ-PF demonstrated that they are fair predictors in diagnosing DO and USI. As the OAB and SUI score on ePAQ-PF increased so did the likelihood of DO (up to a score of 75) and USI on UDS.

Nocturnal enuresis: prevalence and associated LUTS in adult women attending a urogynaecology clinic

INTRODUCTION

Nocturnal enuresis (NE) is an underreported symptom with a profound impact on quality of life. The primary objective of this study was to investigate the prevalence of NE and its association with other lower urinary tract symptoms (LUTS).

METHODS

A validated pelvic floor questionnaire [electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF)] was completed by 2302 women attending a urogynaecology clinic over a 3-year period. Association between NE and overactive bladder (OAB), stress incontinence (SUI) and nocturia was assessed using logistic regression. Subgroup analysis was performed on women with NE undergoing transvaginal tape (TVT). Ethical approval was acquired from the University of Sheffield and statistical analysis performed using SPSS version 22.

RESULTS

The overall prevalence of NE reported in the cohort was 23 % (536 women). The reporting of NE was significantly associated with OAB (p < 0.005), SUI (p < 0.005) and nocturia (p < 0.005). Of 84 women undergoing TVT, 49 % reported NE preoperatively. These women reported significantly more severe symptoms of SUI and OAB (p < 0.05). Sixty percent reported improvement or cure of NE postoperatively, and this was dependent on improvement or cure of SUI (p < 0.005). The presence of NE was a negative predictor for improvement in symptoms of SUI following TVT (p = 0.037).

CONCLUSION

This study provides insight into NE, a commonly reported symptom in women attending urogynaecology clinics. To our knowledge, this is the first study to implicate stress incontinence as an important aetiological factor in women with NE. Further studies are required to better understand the aetiology of NE in adult women and relate this to management and outcome.

Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence?

AIM

Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive treatment for faecal incontinence. Many patients with faecal incontinence have coexisting pelvic floor disorders such as urinary incontinence and vaginal symptoms. We utilized a pelvic floor assessment tool to analyse any effect of PTNS on global pelvic floor function.

METHODS

Patients with faecal incontinence attending our institution who had failed to respond sufficiently to biofeedback were offered a course of PTNS. Patients underwent pre- and post-stimulation assessment with a validated electronic Personal Assessment Questionnaire - Pelvic Floor (ePAQ-PF) for pelvic floor disorders. Scores were compared to assess the effect of treatment on global pelvic floor function.

RESULTS

During the study period pre- and post-stimulation ePAQ-PF data were available for 60 patients (55% of all patients starting PTNS). In this cohort there was a significant improvement in bowel continence, bowel related quality of life, irritable bowel syndrome and bowel evacuation with a large effect size for continence and bowel related quality of life. There was also a significant improvement in non-bowel related symptoms, including urinary pain and stress incontinence, urinary related quality of life and bowel related sexual function. Sixty-five per cent of those who answered the question reported improvement in global health after stimulation.

CONCLUSION

For patients presenting with faecal incontinence, PTNS appears to have a positive effect on bowel related function in approximately two-thirds of patients. However, for treatment responders, improvement appears to relate mainly to improvement in bowel related function rather than a global pelvic floor effect.