Prevalence and Quality of Life among Overweight and Obese Women with Different Severity and Types of Urinary Incontinence

OBJECTIVE

Urinary incontinence (UI) is an involuntary leakage of urine and affects the social, physical, and psychological aspects of many individuals worldwide. The purpose of our study was to examine the prevalence, quality of life (QoL), severity, and different types of UI in overweight and obese women.

METHODS

We conducted a cross-sectional study of 1,351 consecutive patients, who were recruited between June 2021 and May 2022.

RESULTS

The mean age of the patients was 39.7 ± 14.2 years with less than a half in the 19-35-year age group (46.9%); 65% of the subjects were overweight or obese. The overall prevalence of UI was 61.2%. Overweight and obesity accounted to 70.2% of patients with mild to very severe UI. The risk estimates to have UI were 1.84 in overweight and 5.4 in obese group. The risk estimate for severe and very severe UI was 2.33 in overweight and 10.34 in obese group. When considering all subtypes, 67.9% of women with overweight and obesity had any of the subtypes, urge UI, stress UI, and mixed UI. Overweight and obesity were significantly associated with poor QoL in women with UI (p < 0.0001). Among 36.1% of all patients with poor QoL, 79.9% were overweight and obese.

CONCLUSIONS

Overweight and obesity are important risk factors of UI affecting daily activity and QOL considerably. As the number of people with obesity is increasing, the prevalence of UI with increased severity is likely to increase in young to mid-aged women. Weight loss should be considered as first-line treatment for this patient population.

Factors involved in the persistence of stress urinary incontinence from postpartum to 12 years after first delivery

AIMS

The aim of this study was to investigate constitutional-, pregnancy-, labor-, and delivery-related factors involved in the long-term persistence of stress urinary incontinence (SUI) from 6 months postpartum to 12 years after first delivery. We also evaluated severity and impact on quality of life of persistent SUI.

METHODS

This was a longitudinal study including primigravid women who gave birth at our Public Health Hospital during 2007. Urinary symptoms were investigated at inclusion, 6 months and 12 years after delivery. Persistent SUI was defined as SUI reported both at 6 months postpartum and 12 years after first delivery. The International Consultation on Incontinence-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the Incontinence Severity Index (ISI) were used to evaluate SUI.

RESULTS

During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up visit, and 315 formed the study group. SUI persisted in 36 out of 44 (81.8%) women. With the ISI, 52.8% of these women were categorized as having slight, 41.7% moderate, and 5.6% severe incontinence. The mean ICIQ-UI-SF score was 7.13 (SD 3.51). Pregnancy SUI (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.10-9.80) and active second stage of labor more than or equal to 1 hour (OR, 3.68; 95% CI, 1.21-11.14) were independently associated with persistent SUI.

CONCLUSIONS

Women who reported SUI during pregnancy, and those who had pushed for more than or equal to 1 hour in the second stage of labor were at greater risk of SUI persisting from 6 months postpartum to long after delivery. We found this independent association after controlling for several constitutional-, pregnancy-, labor-, and delivery-related variables.

Women's Experience with Stress Urinary Incontinence: Insights from Social Media Analytics

PURPOSE

We conducted a large-scale digital ethnographic analysis of anonymous online posts to capture the complete patient experience, knowledge and perceptions among women with stress urinary incontinence.

MATERIALS AND METHODS

Online posts were identified through data mining. Overall, 200 randomized posts were analyzed using grounded theory qualitative methods. To ensure full thematic discovery we also applied a Latent Dirichlet Allocation probabilistic topic modeling approach to the entire data set of identified posts. Latent Dirichlet Allocation topics are represented as a distribution of words, similar to a word cloud, which were manually reviewed to identify themes.

RESULTS

A total of 985 online posts by 762 unique users were extracted from 98 websites. There was significant overlap between the grounded theory and Latent Dirichlet Allocation identified themes. Our analysis suggests that these online communities help women manage the quality of life impact of their stress urinary incontinence, navigate specialty care and reach a decision regarding surgical vs nonsurgical management. Additionally, we identified risk factors, prevention strategies and treatment recommendations discussed online.

CONCLUSIONS

Findings demonstrated patient values that may influence decision making when seeking care for stress urinary incontinence and choosing a treatment. Social media interactions provide insight into patient behaviors that are important in order to improve patient centered care and decision making.

Possibilities of objectivization of pelvic floor muscle exercises in patients with urine leakage after delivery

BACKGROUND

Examination of pelvic floor muscle function is very important before starting exercises in patients with urine leakage and other pelvic floor dysfunctions. Perineometer and palpation examination is currently being used. A new trend in physiotherapy is the ultrasound examination of pelvic floor muscles. The examination can be performed by abdominal approach or perineal approach. We evaluate 2D and 3/4D images of pelvic floor muscles.

METHODS

The International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). OAB-q - overactive bladder questionnaire - short form. The Urinary Incontinence Quality of Life scale (I-QoL) - self-assessment scale for assessing the quality of life of patients with urinary incontinence. Adjusted Oxford scale to assess pelvic floor muscle strength. PERFECT scheme by Laycock and Jerwood. Pelvic floor examination by perineometer (Peritron-Ontario, L4V, Canada). Pelvic floor examination by 2D and 3/4D ultrasound examination (Volunson-i BT 11 Console, VCI volume contrast imaging software, (GE Healthcare Austria GmbH & Co OG, Zipf, Austria, RAB4-8-RS 3D/4D 4-8 MHz probe). High intensity exercise of pelvic floor muscles with stabilization elements.

CONCLUSION

The effect of pelvic floor muscle training was objectively proved by the above mentioned objectivization methods with subjective improvement of quality of life. There was also a significant effect of education in USG exercise.

Effect of Pulsed Magnetic Stimulation on Sexual Function in Couples With Female Stress Urinary Incontinence Partners

We prospectively evaluated the effects of pulsed magnetic stimulation (PMS) on sexual function of couples with stress urinary incontinence (SUI) partners. Female SUI subjects received 16 or 32 biweekly PMS sessions, depending on treatment response. Prior to, immediately after, and at 6-months posttreatment, couples completed the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire. Fifty-three (80.3%) of 66 couples completed reassessments. Based on the overall GRISS score, there were significant improvements in sexual function in both female subjects (M_diff -5.05, SE 1.34, p = 0.001) and their partners (M_diff -3.42, SE 1.24, p = 0.026). Our findings suggest that PMS improved sexual function of SUI patients and their partners.

Quality of life and objective outcome assessment in women with tape division after surgery for stress urinary incontinence

BACKGROUND

Midurethral tapes may cause long-term complications such as voiding dysfunction, groin pain, de novo urgency or mesh erosion, which necessitate a reoperation. There is a paucity of data regarding health related quality of life in patients undergoing tape removal. The aim of the study was to evaluate quality of life (QoL) and objective outcome after midurethral tape division or excision.

METHODS

All patients who underwent a midurethral tape division for voiding difficulties, pain or therapy resistant de novo overactive bladder between 1999 and 2014 were invited for follow-up. A control group with a suburethral tape without division was established in a 1:2 ratio and matched for age, tape used and year of tape insertion. Patients completed the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire, Female Sexual Function Index Questionnaire and the Patient Global Impression of Improvement score.

RESULTS

Tape division or excision was performed in 32 women. Overall, 15 (60%) of 25 women who were alive were available for clinical examination and completed the questionnaires. Tape division was performed for voiding dysfunction (n = 7), overactive bladder (n = 2), mesh extrusion (n = 3) and ongoing pain (n = 3). Median time to tape division/excision was 10 months. Three women in the tape division group had undergone reoperation for stress urinary incontinence (SUI). At a median follow-up of 11 years (IQR 9-13) subjective SUI rate was 53% (8/15 women) in the tape division group and 17% (5/30) in the control group (p = 0.016), with no significant differences in objective SUI rates between groups. With regard to quality of life, the study group had significantly worse scores in the SUI related domains role limitation, physical limitation, severity measures and social limitations (KHQ) compared to the control group.

CONCLUSIONS

Women needing tape division or excision have lower SUI related QoL scores compared to controls mostly because of higher subjective SUI rates.

[Vesicourethral anastomotic strictures and urinary incontinence following radical prostatectomy: relationship and impact on patients quality of life before and after endoscopic correction]

AIM

To assess the incidence and grade of concomitant stress urinary incontinence (SUI) and the quality of life before and after endoscopic correction of vesicourethral anastomotic strictures (VAS) and the impact of the number of endoscopic interventions on these indicators.

MATERIALS AND METHODS

This is a retrospective study of medical records and a telephone survey of patients who underwent radical prostatectomy (RP) at our clinic from 2010 to 2015 and subsequently presented with VAS. The survey included data on the severity of SUI and quality of life using QoL questionnaire before and after endoscopic VAS correction; the factors primarily affecting the quality of life (SUI or obstructive symptoms) were identified.

RESULTS

During the above period, 1453 RP were performed. There were 60 VAS cases, of which 56 (93%) were included in the study. Stress urinary incontinence after RP occurred in 64.3% of patients, the average QoL score was 3.95 ( = 0.64; Cv = 16.2%). Before endoscopic VAS correction, 87.5% of patients reported obstructive symptoms as the main cause of dissatisfaction. After endoscopic VAS correction, SUI was observed in 82.1% of patients. De novo incontinence occurred in 15 patients, higher SUI grade was observed in 29 (51.8%) patients. The observed change in the of SUI grade was not statistically significant (paired Students t-test 1.98, p> 0.05). Mean QoL score after endoscopic correction was 2.54 ( = 0.73; Cv = 28.6%, paired Students t-test 5.08, p <0.05). After endoscopic correction of VAS, 78.6% of the patients reported that SUI was the most important factor for decreased quality of life.

CONCLUSIONS

The study revealed a high incidence of VAS combined with SIU. There was a significant improvement in patients quality of life after endoscopic correction of VAS, which resulted from a change in the pattern of voiding dysfunction producing a major negative impact on the quality of life. There were no statistically significant correlations between the number of endoscopic corrections of VAS and the SUI grade and the patients quality of life.

A comparison between adjustable single-incision sling and tension-free vaginal tape-obturator in treating stress urinary incontinence

PURPOSE

To compare the subjective and objective cure rates, postoperative pain, postoperative complications, and postoperative quality of life of adjustable single-incision sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the treatment of female stress urinary incontinence (SUI).

METHODS

Female patients with SUI (N = 368) were randomized to receive either Ajust® (N = 184) or TVT-O™ procedure (N = 184) between January 2012 and October 2013. Efficacy was evaluated using cure rate, postoperative complications, postoperative pain profile (using Visual Analogue Scale), Patient Global Impression of Improvement Scale, and International Consultation on Incontinence Questionnaire-Short Form.

RESULTS

The patients from Ajust® and TVT-O™ groups had no statistically significant difference in subjective and objective cure rates (94.4 vs 90.7 %, P = 0.171; 97.2 vs 90.7 %, P = 0.195). Compared with the TVT-O™ group, patients in the Ajust® group had significantly less postoperative pain, shorter operative duration, and less intraoperative blood loss (all P values < 0.05). No significant difference in perioperative complications was observed between these two groups. Patients in Ajust® group had shorter recovery time (P < 0.001) compared to TVT-O™ group. The postoperative quality of life of patients in these two groups was significantly improved compared to baseline; however, no significant difference was observed in the average improvement of life between these two groups (P = 0.115).

CONCLUSIONS

Ajust® procedure is simple, safe, and effective for the treatment of SUI. Compared with TVT-O™, patients receiving Ajust® had less intraoperative blood loss, less postoperative pain, and shorter recovery time.

[Comparison of quality of life of patients treated for SUI by surgical approaches AJUST and TVT-O - a 3-month results from randomized trial]

OBJECTIVE

The aim of this study is to compare quality of life in 3-month follow-up after the use of transobturator tape TVT-O and single incision tape AJUST in the treatment of urodynamic stress urinary incontinence (USI).

DESIGN

Randomized trial.

SETTING

Gynekologicko-porodnická klinika LF UK a FN Plzeň, Gynekologicko-porodnická klinika 1. LF UK a VFN Praha.

MATERIALS AND METHODS

Between May 2010 and May 2012 100 women with proven urodynamic stress urinary incontinence were included in this randomized trial. These patients were randomly chosen and devided into two group: 50 patients for TVT-O procedure and 50 patients for AJUST procedure. All of the patients underwent a complete urogynecological examination prior to the actual procedure (clinical examination, urodynamic examination, ultrasound examination) and filled in ICIQ-SF and iQol questionnaires. After the surgery, the patients satisfaction was evaluated by visual analoque scale (VAS) and Likert scale and by ICIQ-SF and iQol questionnaires. The intensity and length of postoperative pain was monitored using the visual analogue scale. The patients underwent an examination after 3 months.

RESULTS

In both groups of participants no significant differences regarding age, BMI, parity, history of surgery for gynecological disorders, were found. Preoperative urodynamic, ICIQ-SF and iQol parameters were also not significantly different. In the 3-month follow-up 48 participants from TVT-O group and 50 participants from the AJUST group were monitored. No statistically significant differences in subjective and objective parameters were found. Subjectively stress incontinence was not present in 97.9% in the TVT-O and 96.0% in the group AJUST. Objectively stress test was negative in 93.8% in the TVT-O and 94% in group AJUST. By evaluating the ICIQ and iQol were found no statistical differences in the quality of life in both operating groups.

CONCLUSION

At 3-months follow up we did not find any statistical difference between subjective and objective outcome for single incision tape AJUST and TVT-O. In the AJUST group lower intensity and shorter duration of postoperative pain were observed.

Urinary incontinence in spina bifida: Initial instrument validation

The purpose of this study was to perform a psychometric assessment of the Incontinence Symptom Index-Pediatric (ISI-P) in a cohort of adolescents with spina bifida (SB) and neuropathic urinary incontinence (UI) to test its validity and reliability. The ISI-P, an 11-item instrument with domains for symptom severity and impairment, was self-administered by subjects 11-17 years old with SB and UI. Controls were 11-17 years old, with nephrolithiasis and no history of UI. Formal psychometric assessment included an evaluation of internal consistency, test re-test reliability and factor analysis. Of 78 study-eligible subjects we attempted to contact, 33 (66.7% female) with a median age of 13.1 years completed the ISI-P (42.3% response rate). 21 control patients also completed the ISI-P. Cronbach's alpha was 0.936 and 0.792 for the severity and bother factors respectively. The delta Chi-square test for the two-factor (vs. one-factor) model was significantly [χ(2)(89) = 107.823, p < 0.05] in favor of the former model with descriptive fit indices being excellent (e.g., comparative fit index = 0.969). Furthermore, category information analysis showed that all categories were associated with different threshold values, namely that each category contributed unique information for the measurement of the latent trait. In conclusion, the ISI-P has desirable psychometric properties for the measurement of UI symptom severity and impairment in adolescents with SB.

[Urinary stress incontinence - one of basic diseases of modern society]

One of the most common women's chronic diseases is urine incontinence (UI). Currently considered to be a social disease of women in all age groups. The etiology of urine incontinence is multifactorial and the most common is stress urinary incontinence (SUI). UI is a interdisciplinary problem, lying in the sphere of interests of different specialties. According to the recommendations of the Polish Gynecological Society IU diagnostics can be divided into a preliminary stage and specialized stage. Initial diagnosis should start by gathering medical history and it can be completed by quality of life questionnaire. Today, one of the non-invasive diagnostic methods is the ultrasound study. In a situation where diagnosis can not be placed or when surgical treatment is needed, the patient should have urodynamic study. Conservative methods and surgery are used in the treatment of SUI. Conservative procedure should be the first choice in patients with symptoms of IU. Over 200 types of various operations have been described in the history of the surgical treatment of SUI. Until now the most common are: Burch colposuspension, TVT and TOT and implantation of an artificial sphincter.

Psychosocial problems of women with stress urinary incontinence

OBJECTIVE

The aim of the study was evaluation of the influence of stress urinary incontinence on women's quality of life.

MATERIAL AND METHOD

The study covered 275 women between 30-65 years of age. The study was conducted using the following tools: Gaudenz Questionnaire, King's Health Questionnaire (KHQ), Female Sexual Function Index (FIFI) Questionnaire, and a questionnaire devised by the authors of the study.

RESULTS

The study shows that the disease has a negative effect on evaluation of the quality of thee women's lives. The symptoms of stress urinary incontinence had a significant influence on the feeling of emotional comfort, social and professional activity of the surveyed women - respectively p= 0.000; p=0.000; p=0.000. Nearly every third woman (28.7%) felt great mental discomfort related to the disease symptoms, 31.7% a considerable discomfort, 33.1% a moderate, and very few women (6.5 %) claimed that the disease had a minimal effect on their emotional state. About two-thirds of the surveyed women (68.7%) were sexually active, and the remaining 31.3% declared the lack of sexual intercourse.

CONCLUSIONS

The occurrence of stress urinary incontinence symptoms affects the quality of life of women, especially their mental state and interpersonal contacts. Most women with the symptoms of stress urinary incontinence fulfill their sexual needs; however, many of them do not feel complete satisfaction with their sex life.

Women's experiences of internet-based or postal treatment for stress urinary incontinence

Stress urinary incontinence is common and sometimes embarrassing. New, simple, and easily accessible treatments are needed. We telephone interviewed 21 women who participated in a randomized controlled study comparing two treatment programs based on instructions for pelvic floor muscle training. One program was Internet-based and included email support by a urotherapist; the other was sent by post. There was no face-to-face contact in either program. Our main aim was to explore the women's experiences of the Internet-based treatment. Grounded theory analysis revealed three categories: hidden but present, at a distance but close, and by myself but not alone. These were incorporated in a core category: acknowledged but not exposed. The leakage was often a well-hidden secret, but the study treatments lowered the barrier for seeking care. In the Internet group, a supportive patient-provider relationship developed despite the lack of face-to-face contact. Internet-based treatment programs can increase access to care and empower women.

Effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state

OBJECTIVE

Our aim was to investigate the effects of urinary incontinence subtypes on women's quality of life (including sexual life) and psychosocial state.

STUDY DESIGN

The patients, who applied to our clinic from March 2011 to August 2011, were identified and stratified into three groups: those with stress incontinence proved urodynamically (USI), those with urge incontinence (UI), and those with mixed incontinence urge incontinence (UI) proved by urodynamic and clinic evaluation. Scores on the Beck anxiety inventory (BAI), pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), urogenital distress inventory (UDI-6), and incontinence impact questionnaire (IIQ-7) were compared between the urinary incontinence subtypes.

RESULTS

According to urodynamic and clinical examination of 111 women with urinary incontinence, 59 (53%) had USI, 35 (32%) had UI, and 17 (15%) had MI. BAI-scores significantly differed between the USI and UI groups (p=0.030) and between the USI and MI groups (p=0.011) not between the UI and MI groups (p=0.597). UDI-6 scores did not significantly differ between the three groups (p=0.845). IIQ-7 scores significantly differed between the USI and MI groups (p=0.003) and between the UI and MI groups (p=0.006) but not between the USI and UI groups. Patients with USI had significantly lower PISQ-12 scores than those with UI (p=0.015).

CONCLUSIONS

These differences in the effects of incontinence subtypes should be kept in mind in the evaluation of patients with urinary incontinence. Psychiatric assessment may improve the management of incontinence in women, especially UI and MI.

Tension free vaginal tape (TVT) vs Transobturator tape (TOT) complications and outcomes

BACKGROUND

Stress urinary incontinence (SUI) is managed with both TVT and TOT. The TVT route of placement could result in a higher com-plication rate. The aim of this study is to analyze and compare outcomes and complications of TVT and TOT in SUI treatment.

METHODS

Prospective study in 64 women with isolated SUI was validated through Urogenital Distress Inventory (UDI-6), Incontinence Impact questionnaire (IIQ-7) and International Continence Impact Questionnaire (ICIQ5-SF). Intraoperative and postoperative complications were noted. Patients were considered cured when negative on stress test and with no need for additional surgery during follow up, after one and three months.

RESULTS

The cure rates for both TVT 26/30 (86,6%) and TOT 30/34 (88,2) were comparable. Higher rates of bleeding, bladder perforations, pain and dyspareunia are recorded in TVT group. Quality of life graded on the questionnaire basis proved significant improvement in both procedures.

CONCLUSION

Both TVT and TOT have comparable cure results in the treatment of SUI. The TOT is equally effective in the SUI treatment with significantly lower complication incidence.

[Efficacy impacts of the different treatment frequencies on female stress urinary incontinence]

OBJECTIVE

To observe the effect on female stress urinary incontinence (SUI) treated with the pudendal nerve stimulation of electroacupuncture therapy at different frequencies.

METHODS

Sixty patients were divided into a group treated three times every week (group A) and a group treated twice every week (group B), 30 cases in each one. The pudendal nerve stimulation of electroacupuncture therapy was adopted at Disixue (four acupoints on sacral region), 60 min in each time in the two groups, treated three times a week or twice a week respectively. SUI severity and the score of life quality were observed before and after 12 treatments separately. The efficacy was evaluated in the two groups.

RESULTS

At the end of treatment, SUI severity was relieved and the score of life quality was improved in the two groups (all P<0.01). The results in group A were superior to group B [0 (0-4.3) vs 4 (0-5), P<0.01]. At the end of treatment, the total effective rate in group A was 90.0% (27/30) and was 76.7% (23/30) in group B; the efficacy in group A was better than that in group B (P<0.05).

CONCLUSION

The pudendal nerve stimulation of electroacupuncture therapy achieves the definite efficacy on female SUI and the results in the treatment of three times a week are superior to those in the treatment of twice a week.

Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence

OBJECTIVES

To evaluate the effectiveness and assess the changes in sexual function and quality of life after placement of a single-incision sling for the treatment of female stress urinary incontinence.

STUDY DESIGN

A prospective study of women diagnosed with stress urinary incontinence. The single-incision sling was implanted and patients were followed postoperatively for 6 months. The postoperative rate of continence, complications, changes in sexual function, and patient-reported quality of life were evaluated. Female Sexual Function in sexually active patients was evaluated before and after the single-incision sling procedure using the Female Sexual Function Index. From January 2009 to November 2011, 73 patients were enrolled and underwent the procedure to implant the MiniArc® or Ajust® single-incision sling.

RESULTS

Overall, 93.2% of the patients who successfully received a single-incision sling demonstrated total restoration of continence (83.6%) or improved continence (9.6%) at the 6-month postoperative visit. Improvements were seen in the quality of life scores related to global bladder feeling (87.7%) and the Female Sexual Function Index (preoperative score 23.86±5.67 vs postoperative score 27.25±4.66 [P<0.0001]).

CONCLUSION

Single-incision sling treatment for stress urinary incontinence led to improvements in continence and sexual function at 6 months of postoperative follow-up.

Medical and psychosocial factors conditioning development of stress urinary incontinence (SUI)

INTRODUCTION

Stress urinary incontinence (SUI) is the most frequent type of urinary incontinence among adult women.

OBJECTIVE

The objective of the study was evaluation of the effect of environmental, systemic and obstetrical factors on the development of stress urinary incontinence, and diagnosing and determination of areas in which changes could be made.

MATERIAL AND METHOD

The study covered 313 females aged 30-75 living in the Lublin Region. The respondents were divided into two groups according to the clinical diagnosis, occurrence of symptoms of SUI or lack thereof: Group I - women with SUI symptoms (119), Group II - women without SUI (194). A diagnostic survey was conducted with the use of a self-designed research instrument based on the Gaudenz questionnaire, data from relevant literature and the 'competent judges' test. The following statistical tests were used to compare two structure indicators (fraction, frequency); chi-square test and t-Student test. Statistical analysis was performed by means of STATISTICA 9 (StatSoft) software.

RESULTS AND CONCLUSIONS

Statistically significant differences were found between the group of patients with SUI and the control group, with respect to the number of deliveries and their duration. The study showed that there is a statistically higher probability of the development of SUI in the case of surgical delivery, or natural childbirth of a baby with a birth weight of 4000 g or more. The study showed that hard physical work and past gynaecological surgeries are risk factors of urinary incontinence. Barriers of a psychosocial nature were also found (feeling of shame and embarrassment accompanying disclosure of the SUI), which minimized the respondents' participation in urinary incontinence prophylactic actions.

Stress urinary incontinence and quality of life: a reliability study of a condition-specific instrument in paper and web-based versions

AIMS

Quality of life is an important outcome measure in studies of urinary incontinence. Electronic collection of data has several advantages. We examined the reliability of the Swedish version of the highly recommended condition-specific quality of life questionnaire International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), in paper and web-based formats in women with stress urinary incontinence.

METHODS

Women aged 18-70 years, with stress urinary incontinence at least once weekly, were recruited via the project's website and answered the ICIQ-LUTSqol questionnaire. Respondents completed either the paper version twice (n = 78), or paper and web-based versions once each (n = 54). The ICIQ validation protocol was followed.

RESULTS

The mean interval between answers was 18.1 (SD = 3.1) days in the paper versus paper setting and 15.0 (SD = 7.8) days in the paper versus web-based setting. Internal consistency was excellent, with Cronbach's alpha coefficients of 0.87 for the paper version and 0.86 for the web-based version. There was a high degree of agreement of overall scores with intraclass correlations in the paper versus paper and paper versus web-based settings: 0.95 (P < 0.001) and 0.92 (P < 0.001), respectively. The mean of each individual item's weighted kappa value was 0.61 in both settings.

CONCLUSIONS

The questionnaire is reliable in women with stress urinary incontinence, and it can be used in either a paper or a web-based version.

Impact of pelvic floor muscle training on the quality of life in women with urinary incontinence

OBJECTIVE

To evaluate the impact of pelvic floor muscle (PFM) training on the quality of life (QOL) in women with stress urinary incontinence (SUI).

METHODS

Prospective clinical trial with 36 women with a diagnosis of SUI confirmed by urodynamic study. Women with neuromuscular diseases, using hormone replacement therapy, and with prolapse stage III and IV were not included. The exercise protocol for the PFM consisted of slow contractions (tonic fibers), followed by rapid contractions (phasic fibers) practiced in the supine, sitting, and standing positions, three times a week for a period of three months. We evaluated the impact of PFM on QOL using the King's Health Questionnaire (KHQ), a voiding diary, and digital palpation to assess the function of the PFMs during the initial evaluation and after three months of treatment. The result was described as means and standard deviations. We used the Wilcoxon test for comparison of the KHQ scores for paired samples, and the significance level was set at 0.05.

RESULTS

There was a significant decrease in the mean scores of the domains assessed by the KHQ regarding the perception of health, impact of the incontinence, limitations of daily activities, physical limitations, social limitations, personal relationships, emotions, sleep/disposition, and measures of severity. In agreement with these results, significant decrease in nocturnal urinary frequency and urinary incontinence, as well as significant increase in muscle strength and endurance were observed.

CONCLUSION

PFM training resulted in significant improvement in the QOL of women with SUI.

Quality of life in women with urinary incontinence

AIM

To determine the characteristics of urinary incontinence and its impact on the quality of life in adult women with urinary incontinence who presented to a tertiary care clinic of Vojvodina from September 2008 to May 2009 for treatment

METHODS

We used a prospective case-control study. Cases were defined as patients (47) with urinary incontinence symptoms. Controls (50) were defined as patients without urinary incontinence who presented to a tertiary care gynecology clinic for other reasons. Both, cases and controls, completed two questionnaires recommended for the evaluation of symptoms, The Urinary Distress Inventory, and quality of life impact The Urinary Impact Questionnaire.

RESULTS

There was a significant correlation between aging (r=0.614; p<0.01), body mass index (r=0.357; p<0.01) and menopause (r= -0.572; p<0.01) and urinary incontinence. All patients had symptoms of stress incontinence, 61.7% had urge incontinence symptoms, 21.3% voiding difficulty and 85.1% dysuria. Ninety-four patients believed that urinary incontinence impaired their quality of life: 50% of patients reported an impaired ability to do household activities, 59.1% avoided social activities, 70.4% reported an impaired ability to travel more than 30 minutes by car or bus, 88.6% avoided leisure activities, 45.5% of patients had impaired emotional health and 34% felt frustrated.

CONCLUSIONS

The dominant type of urinary incontinence in more than half of the respondents was a mixed type, with moderate to very severe problems. Symptoms of urinary incontinence interfere with the performance of everyday household and social activities, causing the appearance of anxiety, depression and frustration, and in more than 50% of women leads to reduced quality of life.

Cost-effectiveness of duloxetine: the Stress Urinary Incontinence Treatment (SUIT) study

OBJECTIVE

To assess the cost-effectiveness of duloxetine compared with conservative therapy in women with stress urinary incontinence (SUI).

METHODS

Cost and outcome data were taken from the Stress Urinary Incontinence Treatment (SUIT) study, a 12-month, prospective, observational, naturalistic, multicenter, multicountry study. Costs were assessed in UK pound and outcomes in quality adjusted life years using responses to the EuroQol (EQ-5D); numbers of urine leaks were also estimated. Potential selection bias was countered using multivariate regression and propensity score analysis.

RESULTS

Duloxetine alone, duloxetine in combination with conservative treatment, and conservative treatment alone were associated with roughly two fewer leaks per week compared with no treatment. Duloxetine alone and with conservative treatment for SUI were associated with incremental quality-adjusted life-years (QALYs) of about 0.03 over a year compared with no treatment or with conservative treatment alone. Conservative treatment alone did not show an effect on QALYs. None of the interventions appeared to have marked impacts on costs over a year. Depending on the form of matching, duloxetine either dominated or had an incremental cost-effectiveness ratio (ICER) below pound900 per QALY gained compared with no treatment and with conservative treatment alone. Duloxetine plus conservative therapy had an ICER below pound5500 compared with no treatment or conservative treatment alone. Duloxetine compared with duloxetine plus conservative therapy showed similar outcomes but an additional cost for the combined intervention.

CONCLUSIONS

Although the limitations of the use of SUIT's observational data for this purpose need to be acknowledged, the study suggests that initiating duloxetine therapy in SUI is a cost-effective treatment alternative.

[Assessments of quality of life in women with urinary incontinence using: King's Health Questionnaire and International Consultation on Incontinence Questionnaire-Short Form]

The differences in quality of life (QOL) impairment due to urinary incontinence between elderly and younger women were evaluated using King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The subjects were 313 women who consulted the Women's Urinary Incontinence Clinic of Saiseikai Central Hospital between March, 2005 and January, 2008. They were divided into those below or above the cut-off age of 55, 60 or 65 years. The difference in QOL impairment was greatest when the cut-off age was 60 years. Similar comparisons were made by dividing the subjects into those aged 65-74 years and those aged 75 years and above, but no significant difference was noted in the score of any KHQ domain or ICIQ-SF between the two groups. The stress urinary incontinence occurred in younger women and caused the severest impairment. The response rate to KHQ in this study was low especially in the elderly, but that to ICIQ-SF was as high in the elderly as in younger age group. Social activities and lifestyle change around age 60 were considered to be associated with the change of QOL impairment in women with urinary incontinence. The stress urinary incontinence caused the severest impairment. KHQ was often difficult for the elderly to complete, but, ICIQ-SF seemed to be easy.

[Remote results of using synthetic loop in the treatment of urinary incontinence in females (8-year study results)]

Out of 21 female patients who had undergone TVT operation for stress urinary incontinence from March 2000 to February 2001, 15 females responded to the interview in the telephone survey conducted in 2009. A Russian version of the King's Health Questionnaire was used. Seven (46.8%) patients assessed the effect of the operation as good, 4 (26.6%) patients--as satisfactory, 2 (13.3%) and 2 (13.3%) as bad and poor, respectively. Thus, a positive effect was achieved in 11 (73.4%) responders, while a negative effect was seen in 4 (26.6%) patients. Nine (60%) patients experienced no effect of urination problem on quality of life, 3 (20%) and 3(20%) patients experienced moderate and strong effect, respectively. Frequent voiding, urgencies at night, imperative voiding and urgent urinary incontinence were recorded in 3 (20%), 4 (26.7%), 2 (13.3%) and 2 (13.3%) patients, respectively. All 15 (100%) responders stated no incontinence in cough, sneezing and physical activity. Thus, our 8-year follow-up confirms that TVT operation is highly effective in stress urinary incontinence in women.

The effect of pelvic floor re-education on comfort in women having surgery for stress urinary incontinence

The purpose of this study was to examine the effect of a pelvic floor re-education intervention on comfort and stress urinary incontinence in women opting for surgical correction. It also explored the patient's feelings regarding the ease and benefit of attending the pelvic floor re-education intervention.

Patient characteristics impacting health state index scores, measured by the EQ-5D of females with stress urinary incontinence symptoms

OBJECTIVE

To describe the characteristics of women seeking treatment for symptoms of stress urinary incontinence (SUI) and to investigate the association of SUI symptoms with generic health-related quality of life (HRQoL) as measured by the EuroQol (EQ-5D) instrument.

METHODS

The Stress Urinary Incontinence Treatment (SUIT) study was a 12-month observational study in four European countries that evaluated the cost-effectiveness of duloxetine compared with other forms of nonsurgical intervention in the treatment of the symptoms of SUI. Four hundred thirty-one physicians observed women seeking treatment for their SUI, and recorded the care provided and the outcomes of that care at enrollment and at 3, 6 and 12 months afterward The impact of SUI on baseline HRQoL as expressed by the EQ-5D index score was assessed by linear and logistic regression.

RESULTS

Three thousand seven hundred sixty-two women were enrolled into SUIT, with the largest patient group from Germany. Overall, the majority of women were postmenopausal, had a mean age of 58.0 years, were not current smokers, and tended to be overweight (mean body mass index [BMI]=27.7 kg/m2), with at least one comorbidity. The health state index scores were significantly and independently influenced by the presence of comorbidity(ies) affecting quality of life, total number of stress and urge incontinence episodes, urinary incontinence subtype, comorbidity(ies) affecting incontinence, BMI, socioeconomic status, educational status, age, and country.

CONCLUSION

This article describes the characteristics of patients at the SUIT enrollment visit, and demonstrates that the number of incontinence episodes has a significant impact on the EQ-5D index score.

Psychosexual biography and the strategies used by women afflicted with stress urinary incontinence during intercourse: two case studies

BACKGROUND

Stress urinary incontinence often leads to major physical, psychological and social problems, and many patients struggle to cope with this illness. The issue of urinary leakage during sex is particularly troublesome.

CASE REPORT

In order to show the relationship between psychosexual biography and the strategies applied to cope with urinary leakage during sexual intercourse, we analyzed the psychosexual biographies of 2 patients with stress urinary incontinence.

CONCLUSIONS

Psychosexual biography influences the choice of strategies used by incontinent women to cope with urinary leakage during sexual intercourse. Normal psychosexual development in all developmental stages conditions proper sexual functioning in women with urinary leakage during sexual intercourse and the choice of less restrictive coping strategies.

Goal achievement as a patient-generated outcome measure for stress urinary incontinence

OBJECTIVES

To explore women's goals and goal attainment for the conservative and surgical treatment of stress urinary incontinence (SUI), and to examine the feasibility of Goal Attainment Scaling (GAS) as an outcome measure in this population.

BACKGROUND

Despite the range of treatments for SUI, little is known about the outcomes patients consider important. Current instruments measure the impact of SUI on the ability to live a 'normal' life without addressing what normal looks like for the patient. Patient-generated measures that address what a patient aims to achieve may fill this gap.

DESIGN

A mixed-methods exploratory design combined semi-structured interviews with validated questionnaires and individualized rating of goal achievement. SETTING AND PARTICIPANTS PARTICIPANTS: with SUI (n = 18) were interviewed in their homes prior to initiation of treatment and 3-6 months afterwards.

MAIN VARIABLES

Participants reported individualized goals pre-treatment and rated goal attainment after surgical and conservative therapy. Quality of life impact and change were measured using short forms of the Incontinence Impact Questionnaire and Urinary Distress Inventory.

RESULTS

Women expressed a median of four highly individualized treatment-related goals but goal achievement following conservative treatment was poor. GAS was not feasible as an outcome measure; women readily identified personal goals but could not independently identify graded levels of attainment for each goal.

CONCLUSIONS

Although further work is needed to examine the most feasible, valid, and reliable method of measuring goal achievement in research, asking patients with UI to identify pre-treatment goals may provide useful information to guide treatment-related decision making.

Quality of life after tension-free vaginal tape surgery for female stress incontinence

OBJECTIVE

To undertake a long-term follow-up evaluation of the quality of life (QOL) of women who had undergone a tension-free vaginal tape (TVT) procedure.

MATERIAL AND METHODS

During the period 1995-2001, 970 women with urinary stress incontinence underwent TVT surgery at the Department of Obstetrics and Gynecology, Falun Hospital. A questionnaire was mailed on average 5.7 years after the TVT procedure. Two incontinence-specific QOL instruments--the Incontinence Impact Questionnaire-7 (IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6)--were administered. An additional questionnaire included general questions and questions about chronic diseases that may be associated with urinary incontinence.

RESULTS

The mean age at surgery was 58.7 years (range 29-89 years). Of 913 eligible women, 768 (78.9%) responded. Mean IIQ-7 and IDU-6 scores as estimated by the women improved dramatically at follow-up as compared to preoperative values: from 43.7 to 11.5 for the IIQ-7 and from 54.2 to 24.0 for the UDI-6 on a scale from 0 to 100 (p = 0.0001 for both). There were few differences in mean QOL scores even 8 years after TVT surgery, compared to those determined a shorter time after the operation. Women with diabetes, chronic constipation, chronic bronchitis and preoperative recurrent urinary infections had a relative improvement in QOL of the same magnitude as that of the remaining study population. Advanced age was negatively associated with an improvement in QOL scores.

CONCLUSIONS

Improvements in measures of QOL after TVT surgery are dramatic and persist for years. Women with concomitant diseases that may be associated with urinary incontinence can be assured that there is a good chance of success with TVT surgery.

Comparison of anxiety between patients with mixed incontinence and those with stress urinary incontinence

OBJECTIVE

Some authors insist that patients with mixed incontinence (MI) suffer from more anxiety than those with pure stress urinary incontinence (SUI) due to the added emotional stress caused by various symptoms of an overactive bladder. We objectively evaluated and compared the degree of anxiety between the two groups.

MATERIAL AND METHODS

Among 172 patients who presented with urinary incontinence, 118 showed MI and 54 SUI. They were surveyed regarding their anxiety using the Beck Anxiety Inventory (BAI) questionnaire.

RESULTS

The mean BAI score was 12.0+/-8.8 in the MI group and 7.8+/-5.2 in the SUI group and this difference was statistically significant (p<0.05).

CONCLUSIONS

This study provides objective evidence that patients with MI have a higher degree of anxiety than those with pure SUI. Therefore, we suggest that doctors should pay more attention to anxiety symptoms when caring for patients with MI.

The impact of stress incontinence surgery on female sexual function

OBJECTIVE

We sought to describe change in sexual function 2 years after surgery to treat stress urinary incontinence.

STUDY DESIGN

This analysis included 655 women randomized to Burch colposuspension or sling surgery. Sexual activity was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) among those sexually active at baseline and 2 years after surgery.

RESULTS

Mean PISQ-12 total score improved from baseline 32.23 +/- 6.85 to 36.85 +/- 5.89. After surgery, fewer subjects reported incontinence (9% vs 53%; P < .0001), restriction of sexual activity as a result of fear of incontinence (10% vs 52%; P < .0001), avoidance of intercourse because of vaginal bulging (3% vs 24%; P < .0001), or negative emotional reactions during sex (9% vs 35%; P < .0001). Women with successful surgery had greater improvement PISQ-12 scores (5.77 vs 3.79; P < .006). Sexually active women were younger, thinner, and had lower Medical, Epidemiological, and Social Aspects of Aging scores (total and urge subscale) than sexually inactive women.

CONCLUSION

Sexual function improves after successful surgery and does not differ between Burch and sling.

Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence

BACKGROUND

Current research focuses on three variables in evaluating the impact of stress urinary incontinence (SUI) on daily living: severity of incontinence, distress or bother resulting from incontinence, and effect on health related quality of life (HRQoL). Understanding the impact of these variables is important as they are the driving force behind women seeking surgical treatment. Given the importance of HRQoL in determining need for treatment, as well as evaluating treatment success, this review provides an assessment of the degree to which HRQoL is impaired in women seeking surgical treatment.

METHODS

PubMed searches for the terms "quality of life and distress and urinary incontinence" and "quality of life and bother and urinary incontinence" were performed with limits of English, human and female subjects through May 2008. All studies using validated instruments were included. No time limit was placed on the search.

RESULTS

Of 178 articles retrieved, 21 met the inclusion criteria, and 17 reported methods of scoring. The studies used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Wide ranges of mean and individual levels of severity of symptoms, UDI and IIQ scores were seen among women seeking surgical treatment. Fourteen studies reported baseline and post-surgical treatment distress and QoL data. Statistically significant improvements between baseline and post-surgical UDI and IIQ scores were reported in 12 studies. Reported cure rates ranged from 46% to 97%. Satisfaction with the procedure was reported in 4 studies and ranged from 84% to 91%. A minority of studies reported the relationship between reduction in symptoms and change in HRQoL.

CONCLUSION

HRQoL is the main reason women seek surgical treatment for incontinence and surgical treatment leads to a significant improvement in mean HRQoL scores. Assessment of HRQoL has proved less useful in identifying why individual women seek treatment for incontinence. Preliminary work has begun to characterize the interaction between severity of symptoms, distress or bother resulting from these urinary symptoms, impact on HRQoL, and treatment seeking behavior, but further research is needed. Greater standardization in the reporting of results of distress or bother and HRQoL would allow for comparison across studies.

Postcesarean pelvic floor dysfunction contributes to undisclosed psychosocial morbidity

OBJECTIVE

To estimate the prevalence and severity of postcesarean pelvic dysfunction.

STUDY DESIGN

Using biopsychosocial interviewing at home, 184 postcesarean primiparas were compared to 100 vaginally delivered women regarding symptoms of stress incontinence, anal incontinence and dyspareunia. Delivery details were confirmed from medical records.

RESULTS

Comparison of postcesarean vs. vaginally delivered women revealed stress incontinence in 33% vs. 54% and dyspareunia in 27% vs. 46%, both differences reaching statistical significance, unlike anal incontinence, which was manifest in 51% vs. 44%. When compared to emergency cesarean the relative risk of stress incontinence following an elective cesarean was 0.99 (0.71, 1.39), of dyspareunia 1.02 and of anal incontinence 1.05, indicating no statistically significant difference. Thirty (22%) stress incontinent and 4 (3%) fecally incontinent mothers used pads continuously, suggesting severe physical morbidity. Severe dysphoria (depression) was expressed by 41 (35%) stress incontinent mothers, 38 (30%) with dyspareunia and 34 (26%) with anal incontinence; the association of severe dysphoria with dyspareunia was statistically significant (OR = 2.504 [1.362, 4.602]). Few women came forward to seek help.

CONCLUSION

Pelvic dysfunction was similar after elective or emergency cesarean. Compared to vaginal delivery, postcesarean stress incontinence and dyspareunia were less frequent but biopsychosocial morbidity could be severe.

Rating improvements in urinary incontinence: do patients and their physicians agree?

OBJECTIVE

to determine whether patients' perceptions of improvement following behavioural interventions for urinary incontinence (UI) correspond with physicians' global ratings of change, and to compare both these ratings with more objective UI outcome measures.

METHODS

consecutive new female patients aged 65 years and older recruited from outpatient UI clinics in Quebec received a behavioural management protocol for UI. At 3-month follow-up, patients and physicians were independently asked for their global impression of change in UI status. Patients completed 3-day voiding diaries and a UI-specific quality-of-life index before and after treatment.

RESULTS

108 patients (mean age 73 +/- 5 years, range 65-86 years) with stress, urge and mixed UI participated. There was concordance between patients' and physicians' ratings of change in 57% of cases. Among the remaining cases, patients were 1.6 times as likely to report significant improvements compared to physicians. Patients' ratings correlated more strongly with improvements in UI episodes in the voiding diary (r = 0.4, P = 0.002 versus r = 0.3, P = 0.004 for physicians) and on the quality-of-life index (r = -0.5, P < 0.0001 versus r = -0.4, P < 0.0001 for physicians).

CONCLUSION

physicians underestimate clinically meaningful changes in UI in older women following behavioural interventions.

Stress urinary incontinence: prevention, management, and provider education

The costs of urinary incontinence (UI) are financially and socially substantial to those who are living with its effects. When looking at the dramatic costs associated with UI and associated pelvic floor disorders, prevention of these disorders or management at the earliest possible level is indicated. Determining which modifiable factors cause UI and pelvic floor disorders is complicated. Listening to patients in an effort to improve their quality of life may be a reasonable starting point. Educating future health care providers to approach these topics with sensitivity will positively impact the care patients receive.

Long-term results of tension-free vaginal tape for female urinary incontinence: follow up over 6 years

OBJECTIVE

To describe the long-term outcome of using tension-free vaginal tape (TVT) with and without associated procedures.

METHODS

A questionnaire was mailed to a population of 61 women who had undergone TVT surgery more than 6 years ago. Of this population, 41 (80%) had suffered from stress urinary incontinence (SUI). The questionnaire included questions about urinary symptoms, satisfaction and quality of life. The questionnaire was answered by 51 of the 61 women.

RESULTS

Mean follow up was 83 months. The women with SUI had a persistent cure rate of 80% with a satisfaction rate of 97%. The cure rate after 6 years was 37% in women with mixed incontinence. Concomitant hysterectomy (relative risks = 0.87) and body mass index (BMI) do not alter the long-term results of TVT procedure. Peroperative bladder injury is not associated with an increased risk of long-term lower urinary tract symptoms (LUTS) or with a decreased satisfaction rate (relative risks = 0.85).

CONCLUSIONS

Concomitant hysterectomy, increased BMI and bladder injury do not alter good long-term results of TVT.

Are there differences between women with urge predominant and stress predominant mixed urinary incontinence?

OBJECTIVE

We sought to determine if there are differences in clinical and urodynamic parameters between women with urge predominant and those with stress predominant mixed urinary incontinence (MUI).

METHODS

Charts of 99 female patients with complaints of MUI were reviewed. Patients were divided into two groups based on the subjective predominance of either stress incontinence (MSUI) or urge incontinence (MUUI). All patients completed a subjective evaluation including an AUA Symptom Index, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). Objective non-invasive measures included physical exam, 48-hr voiding diary, and a 24-hr pad test. Videourodynamics studies (VUDS), performed in all patients, were reviewed and the presence and characteristics of detrusor overactivity (DO) and stress incontinence were noted.

RESULTS

There were no significant differences between groups with respect to symptom scores. MUUI patients had significantly higher pad usage, and lower maximum and average voided volumes than MSUI patients. They were also more likely to have lower urodynamic bladder capacities and demonstrable DO (70% vs. 26%) on VUDS with contractions occurring at lower bladder volumes and with higher amplitude. MSUI patients were more likely to have demonstrable SUI on physical examination (63% vs. 16%) and on VUDS (100% vs. 61%).

CONCLUSIONS

There do appear to be differences in clinical and urodynamic parameters between patients with stress predominant and urge predominant MUI. These may help to determine which component of the mixed incontinence is more problematic.

[The influence of SUI operative treatment with use of IVS tape on quality of life]

OBJECTIVES

Real influence of urinary incontinence symptoms and adopted modes of treatment on patient's quality of life is not known.

DESIGN

Assessment of influence of operative SUI treatment with the use of IVS tape on patient's quality of life.

MATERIAL AND METHODS

Prospective study was conducted among 57 patients with SUI symptoms II and III degree (type III according to Blavais), who were classified to apply IVS tape. Diagnostic investigations were completed by questionnaires: IIQ-7 and UDI-6, which were filled by patients. In analysis there were included results obtained before the operation and 6 months after procedure.

RESULTS

We recognized women as cured: based on physicians anamnesis--80.7% of patients, according to UDI-6 --71.93%. Half year after operation relevant improvement of quality of life, evaluated by IIQ-7 questionnaire, showed 89.47%. Improvement of quality of life correlated with lack of SUI symptoms in anamnesis (r = 0.631; p < 0.001) and in UDI-6 questionnaire (r = 0.597; p < 0.001).

CONCLUSIONS

(1) Operation with the use of IVS tape is effective according to improvement of quality of life in majority of patients treated due to SUI. (2) Efficacy of operative treatment in domain with SUI symptoms correlates with influence of procedure on quality of life. (3) Assessment of SUI operative treatment should include analysis of SUI symptoms and their influence on quality of life, achieved upon standardized questionnaires filled by patients.

[Diagnostics of stress-incontinence in women]

In experimental model, imitating lower urinary tract was detected the significance of urodinamic researches for diagnostic of stress incontinence. We suggested math formules for determine opening and closing of sphincter and their connection to the bladder volume, on the basis of uroflowgrame analysies, where was noted the uncontroled leakege of liquid (urine). By cystometry was detected the connection between opening of urethral sphincter and the pressure of the bladder, when was determined the stress incontinence. It was concluded that urodinamic figures have significant diagnostical value at stress incontinence and could help in choosing conservative treatment or surgery.

Which questionnaire? A psychometric evaluation of three patient-based outcome measures used to assess surgery for stress urinary incontinence

AIMS

The aim of the study was to further validate three patient-based outcome measures (PBOM) used to assess the outcome of surgery for stress urinary incontinence and to compare their psychometric properties with a view to determining the most appropriate measure for clinical use.

METHODS

The work was embedded within a randomized controlled trial of laparoscopic and open colposuspension. The trial recruited 291 women from six centers. The three instruments compared were Bristol Female Lower Urinary Tract Symptom Questionnaire (BFLUTS), Kings Health Questionnaire (KHQ), and the Symptom Severity Index and Symptom Impact Index (SSI/SII). The International Consultation on Incontinence (ICI) ABC grading system of psychometric propertie's reliability, validity, and responsiveness was used to evaluate the instruments.

RESULTS

From the analysis of the psychometric properties of the three instruments, the SSI/SII appeared to have the best psychometric profile; Grade A, BFLUTS was of grade A, and KHQ was of grade B. SSI/SII had a good degree of internal consistency (Cronbach's alpha 0.74-0.78). BFLUTS and KHQ both had domains in which the internal consistency was <0.7. The SSI domain of the SSI/SII was the only domain to correlate to the 1-hr pad test. All domains of the SSI/SII were able to distinguish those cured from not cured and it was most responsive to change. Unlike the KHQ, the SSI/SII had no significant ceiling or floor effects.

CONCLUSIONS

This study has demonstrated that when instruments are used in different populations their psychometric properties may change. All three instruments analyzed had limitations when used as an outcome measure for surgery for stress urinary incontinence.

Impact on quality of life of different lower urinary tract symptoms in men measured by means of the SF 36 questionnaire

OBJECTIVE

To describe how different lower urinary tract symptoms (LUTS) affect the quality of life (QOL) in men.

MATERIAL AND METHODS

The study included 1008 men aged 40-80 years living in the community of Surahammar, Sweden who had answered a questionnaire concerning stress incontinence, urgency and post-micturition dribbling 12 months earlier. The occurrence and severity/frequency of 12 specific LUTS were assessed using the Danish Prostatic Symptom Score questionnaire. QOL was evaluated using the Short Form 36 (SF-36) questionnaire.

RESULTS

Post-micturition dribbling was the most frequently reported symptom (71%) and stress incontinence the least common (11%). Men who experienced urge, stress or "other incontinence" had lower mean scores for all of the eight dimensions measured by the SF-36 than men without such symptoms. Furthermore, men who experienced a moderate/severe degree of weak stream or nocturia reported a poorer QOL for all dimensions compared to men with a mild level of the same symptoms. QOL was found to decrease with increasing age. Men aged 66-80 years with "other incontinence" reported lower mean SF-36 scores for physical functioning, role physical, role emotional, social functioning and body pain than 40-65-year-old men.

CONCLUSIONS

LUTS in men affect QOL dimensions differently. Storage symptoms appear to reduce QOL more than voiding and post-micturition symptoms. Urinary incontinence affected all eight of the dimensions evaluated. Elderly men with LUTS reported a lower QOL than younger men.

[Self reported quality of life among patients referred to a gynaecologic ward with urinary incontinence]

INTRODUCTION

Urinary incontinence (UI) represents a frequent symptom among women of all ages. However, very few women are admitted to a hospital or clinic because of UI. The aim of the paper was to characterize women admitted to hospital because of UI in respect to symptoms and self reported quality of life.

MATERIALS AND METHODS

The study comprised all 174 women admitted to a gynaecologic ward due to lower urinary tract symptoms (LUTS) in the period from 1 November 1999 to 1 August 2001. A total of 142 women (82%) completed validated questionnaires on symptoms and quality of life and were included in this analysis.

RESULTS

The median age was 59 years. The majority (97%) had UI at least once a week. Many patients reported other LUTS--in particular nocturia (87%) and urgency (81%). Two-thirds of the women experienced UI as a major problem. The single most affected factor in terms of quality of life--mental well being--was compromised in two-thirds of the cases. Half of all women were incontinent for flatus, one-third for loose stools and one tenth for normal stools occasionally or more frequently. One out of four women experienced anal incontinence as a major problem.

CONCLUSION

The study shows that the quality of life among women referred to a gynaecologic ward because of LUTS is severely affected. Moreover, the study demonstrates a close association between UI symptoms and symptoms indicating pelvic floor malfunction, such as LUTS and anal incontinence.

Determinación de las preferencias de las mujeres sobre el tratamiento de la incontinencia urinaria de esfuerzo mediante el método de la comparación de parejas

OBJECTIVES

To know the preferences of patients with stress urinary incontinence (UI), may facilitate the decision making process of resources allocation and it also may help the choice of more suitable treatment.

METHODS

Cross-sectional study of 150 women who consulted at a UI-specialized unit and with diagnostic of stress urinary incontinence. All patients underwent the diagnostic protocol of the urogynaecological unit. A personal interview was carried out including detailed information of three different treatments (Pelvic Floor Muscle Exercises-PFME, pharmacologic treatment and surgery) and the "Preferences Questionnaire" designed with the method of paired comparisons. A ranking scale was constructed with the alternatives and the distance between them was assessed applying the "law of comparative judgements".

RESULTS

Patients preferred treatment with PFME to the other two options in the whole sample and in two age groups: equal or under 46 years and between 56 and 62 years. Patients between 47 and 55 years seem to prefer pharmacologic treatment. The group of patients aged 63 or over preferred surgery According to severity degree, it seems that PFME treatment is preferred in all degree groups, being the pharmacologic treatment the second choice in moderate and severe degree groups.

CONCLUSIONS

Women with stress UI and who haven't received previous treatment preferred the PFME treatment followed by pharmacologic treatment and surgery.

A safety and quality of life analysis of intravaginal slingplasty in female stress incontinence: a prospective, open label, multicenter, and observational study

This prospective, open label, multicenter, and observational study was performed to determine the efficacy, safety, and the impact of this procedure on the current quality of life (QOL). One hundred three women underwent the intravaginal slingplasty (IVS) procedure. The postoperative evaluation consisted of clinical examination, Incontinence Quality of Life (I-QOL) questionnaire, 3-day consecutive frequency volume chart, free flowmetry, and measurement of post void residual. At 12 months, 83 patients have completed follow-up and are included in this analysis. Patient assessment of continence revealed 89.2% (74/83) cure rate. During follow-up period, one patient (1.2%) has presented with vaginal erosion of the sling material. The I-QOL showed significant improvement in total and three subscale scores at 12 months of follow-up period. This study demonstrated that the IVS procedure provides a safe and effective means for the treatment of female stress incontinence and improvement of QOL.

Quality of life in women with urinary stress incontinence and evaluation of tension-free vaginal tape treatment

OBJECTIVES

Assessment of quality of life in women stress urinary incontinence (USI) and evaluation of tension-free vaginal tape (TVT) treatment.

MATERIAL AND METHODS

The research included a group of 112 women aged 33-78 years. Before as well as 3 and 6 months after the TVT operation, patients were asked to fill in quality of life questionnaires.

RESULTS

After 3 months 87.25% of the women reported full regression of USI symptoms, 7.8% an insignificant improvement, and 4.9% did not observe any change. After 6 months 85.71% reported full regression, 9.18% an insignificant improvement, and 5.1% did not observe any change. USI is responsible for a decrease in physical activity. The most uncomfortable symptom is involuntary urine leakage occurring mainly during an effort or sleep. After the TVT procedure, the majority of women confirmed a significant improvement in quality of life.

CONCLUSIONS

The TVT procedure is an effective method of treating USI in women: it significantly improves quality of life, with a recovery rate of 85-87%, and a low rate of complications.