[Evaluation of women's preferences for the treatment of stress urinary incontinence using the paired comparisons method]. / Determinacion de las preferencias de las mujeres sobre el tratamiento de la incontinencia urinaria de esfuerzo mediante el metodo de la comparacion 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.

Analysis of the value of the ICIQ-UI SF questionnaire and stress test in the differential diagnosis of the type of urinary incontinence.

AIMS: Presently, there is no simple, universally accepted instrument for the initial diagnosis of urinary incontinence (UI), which is why physicians find it so difficult to integrate the diagnosis into their daily clinical practice. The objective of this study is to analyze the true value of the ICIQ-UI SF questionnaire (ICIQ), the stress test, and the combination of both for the diagnosis as to the type of UI. METHODS: Cross-sectional study performed in 116 women consulting for UI symptoms in two specialized health care centers. The subjects completed the ICIQ and underwent a stress test and urodynamic testing which was used for the reference diagnosis. Sensitivity, specificity, positive and negative predictive values, and the statistical "likelihood ratio (LR)" were assessed. RESULTS: According to the ICIQ, 45 women (38.8%) suffered from Stress UI (SUI); 19 (16.4%), Urgency UI (UUI), and 49 (42.2%), Mixed UI (MUI). According to the stress test, 75 (64.7%) presented SUI. According to the combination of both tests, the diagnosis was SUI in 35 (30.2%), UUI in 17 (14.7%), and MUI in 37 (31.9%). Regarding urodynamic testing, observations were as follows: USI in 45 subjects (38.8%), detrusor overactivity (DO) in 25 (21.6%), and combination of both (MUI) in 30 (25.9%). The combination of ICIQ-UI SF plus stress test showed good specificity and negative predictive value, and the best LR coefficients obtained were: 3.11 (USI); 6.64 (UUI); 2.64 (MUI), and 3.77 ("all" SUI). CONCLUSIONS: The combined use of the ICIQ plus stress test will aid in characterizing the type of UI at a basic health care level, favoring the prescription of the most appropriate treatment for each case.

Electrophysiologic studies and clinical findings in females with combined fecal and urinary incontinence: a prospective study.

PURPOSE: Several clinical, urodynamic, and manometric findings suggest neurologic damage as a contributing factor in the development of combined fecal and urinary incontinence. In this study, we wanted to test the hypothesis of pudendal nerve neuropathy being a more frequent lesion in patients with double incontinence compared with patients with isolated fecal incontinence. PATIENTS: Ninety-three females with combined fecal and urinary incontinence and 36 females with isolated fecal incontinence were investigated. All patients underwent anal manometry, endoanal ultrasound, electromyography, and pudendal nerve terminal motor latency. RESULTS: No statistically significant differences were found in the age, history of vaginal delivery, and chronic straining between both groups. However, the rate of postmenopausal females was higher in the combined fecal and urinary incontinence group (85 vs. 67 percent; P = 0.02). Menopause was an independent risk factor of having double incontinence (odds ratio, 1.4; P = 0.02). Concentric needle electromyography of the external anal sphincter revealed increased duration of the motor unit potentials in 43 and 53 percent of patients with combined fecal and urinary incontinence and isolated fecal incontinence, respectively (P = 0.28). An increased number of polyphasic motor unit potentials was detected in 52 and 58 percent (P = 0.6). There was no statistically significant difference in the prevalence of bilateral (20 vs. 27 percent) or unilateral (23 vs. 14 percent) prolonged mean pudendal nerve terminal motor latency between both groups (P = 0.3). CONCLUSIONS: Pudendal neuropathy is not a distinct characteristic of patients with double incontinence. The prevalence of pudendal neuropathy in these patients is similar to that observed in patients with isolated fecal incontinence. Others factors should be investigated to explain the common association of both types of incontinence.

[Evaluation of the results of surgery treatment for female stress urinary incontinence with the ICIQ-UI SF questionnaire]. / Evaluación del resultado del tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en la mujer mediante el cuestionario ICIQ-UI SF.

BACKGROUND AND OBJECTIVE: Our objective was to evaluate the sensitivity to change of the Spanish version of the ICIQ-UI SF. PATIENTS AND METHOD: Prospective study of 71 women with a diagnosis of Stress urinary incontinence (UI) treated with tension free vaginal tape. All had urodynamic diagnostic of Stress UI and ICIQ-UI SF score at the moment of inclusion and after treatment. RESULTS: According to the post-treatment urodynamic evaluation, 45 patients were cured (63.4%). According to the ICIQ-UI SF, 37 patients (52.9%) were cured. Post-treatment scores were lower than pre-treatment ones. Post-treatment scores of cured patients were lower than those of non cured (p < 0.005). The agreement between the ICIQ-UI SF score and the urodynamic evaluation was moderate. CONCLUSIONS: The ICIQ-UI SF questionnaire shows sensitivity to change.