Assessment of pelvic floor muscles in sportswomen: Quality of life and related factors.

OBJECTIVES: To evaluate Maximum Voluntary Contraction (MVC) of the Pelvic Floor Muscles (PFM) in sportswomen, to observe the urinary symptoms and their impact on the Quality of Life (QoL). DESIGN: Observational cross-sectional study. SETTING: Gyms and teams in the North of Portugal. PARTICIPANTS: Sportswomen (n = 197). MAIN OUTCOME MEASURES: The measurement was performed using a manometer. The sportswomen were instructed to perform 3 MVC of the perineum, held for 3 s. The Kings Health Questionnaire (KHQ) was used to evaluate urinary symptoms and the QoL of the sportswomen. RESULTS: Age significantly influenced (p < 0.05) the QoL in all domains. An increase in BMI was also significantly associated with a decrease in the QoL. MVC values had a highly significant effect on the overall QoL and all domains, including a reduction in urinary symptoms. The weekly time of physical activity was associated with a better QoL in symptomatology. The practice of high-impact activities decreased the QoL (compared to low-impact activities). The vaginal resting pressure values ranged from 1.60 to 59.80 (24.34 ± 11.00). CONCLUSIONS: Age, BMI and high-impact sports appear to be the leading factors that promote the onset of SUI, which in turn decrease the QoL in sportswomen. There was a positive association between MVC and weekly time of physical activity in the QoL.

Assessment of the Effectiveness of Pelvic Floor Muscle Training (PFMT) and Extracorporeal Magnetic Innervation (ExMI) in Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study is to assess the effectiveness of pelvic floor muscle training and extracorporeal magnetic innervation in treatment of urinary incontinence in women with stress urinary incontinence. METHODS: The randomized controlled trial enrolled 128 women with stress urinary incontinence who were randomly allocated to either one out of two experimental groups (EG1 or EG2) or the control group (CG). Subjects in the experimental group 1 (EG1) received 12 sessions of pelvic floor muscle training, whereas subjects in the experimental group 2 (EG2) received 12 sessions of extracorporeal magnetic innervation. Subjects in the control group (CG) did not receive any therapeutic intervention. The following instruments were used to measure results in all study groups at the initial and final assessments: Revised Urinary Incontinence Scale (RUIS), Beck Depression Inventory (BDI-II), General Self-Efficacy Scale (GSES), and King's Health Questionnaire (KHQ). RESULTS: In both experimental groups, a statistically significant decline in depressive symptoms (BDI-II) and an improvement in urinary incontinence severity (RUIS) and quality of life (KHQ) were found in the following domains: "social limitations," "emotions," "severity measures," and "symptom severity scale." Moreover, self-efficacy beliefs (GSES) improved in the experimental group that received ExMI (EG2). No statistically significant differences were found between all measured variables in the control group. Comparative analysis of the three study groups showed statistically significant differences at the final assessment in the quality of life in the following domains: "physical limitations," "social limitations," "personal relationships," and "emotions." Conclusion. Pelvic floor muscle training and extracorporeal magnetic innervation proved to be effective treatment methods for stress urinary incontinence in women. The authors observed an improvement in both the physical and psychosocial aspects.

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.

Quality of life assessment in female patients 2 and 4 years after muscle-derived cell transplants for stress urinary incontinence treatment.

INTRODUCTION: Regenerative medicine for the treatment of urinary incontinence has become a popular area of focus in the search for therapies for this disease. The paper focused on women's quality of life assessment who were subjected to transplantation of MDSC (autologous muscle derived stem cells) to the urethral sphincter. METHODS: The procedure was conducted in 16 female patients who completed the observation stage. Assessment of quality of life before and after the treatment (two and four years post-operation) was conducted based on the validated I-QOL questionnaire (the Polish language version). RESULTS: The questionnaire study showed that autologous cell therapy significantly improves quality of life in female patients suffering from stress urinary incontinence (SUI). The total I-QOL score increased from 49 (SD ± 7.7) before therapy to 77 (SD ± 5.4) two years post-operation. Four years after the procedure, quality of life remained at a higher level than before therapy, although quality of life decreased by several points when compared with the results from the two-year follow-up - 63 (SD ± 7.2). Patients reported significantly less concern related to their ability to reach the toilet to avoid incontinence, improved sleep at night, a higher level of satisfaction with life, and more satisfaction with their sexual lives (p<0.05). CONCLUSION: The MDSC injection procedure for SUI treatment has significant improved quality of life in the majority of our patients in 2 and 4 year follow-up.

Effects of a new community-based reproductive health intervention on knowledge of and attitudes and behaviors toward stress urinary incontinence among young women in Shanghai: a cluster-randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: This study aimed to evaluate the prevalence of stress urinary incontinence (SUI) and to introduce a new community-based reproductive health intervention. We then evaluated the effectiveness of this intervention. METHODS: In this cluster-randomized trial, 2100 participants aged 18-40 years were divided randomly into an intervention group (IG, 1400 women) and a control group (CG, 700 women). The CG received traditional community intervention, cmprising limited reproductive information and education; the IG received the new community-based reproductive health intervention model, comprising self-designed handbooks, health lectures, and free medical consultations, in addition to the traditional community intervention. All participants were surveyed face to face using a self-designed questionnaire before and after the 6-month intervention. RESULTS: In Shanghai, the prevalence rate of SUI was 14.3 %. No difference was observed between groups regarding mean knowledge, attitudes, and practices (KAPs) about SUI and the total score at baseline (P > 0.05). The IG scored significantly higher than the CG on the KAP questions at follow-up, and a significant improvement was observed in the IG after the intervention. Total scores increased with age, educational level, income, and time spent working in Shanghai per year but decreased with gravidity and the number of abortions. Native respondents scored higher than did migrants. CONCLUSIONS: The prevalence of SUI is high in Shanghai, and the new community-based reproductive health intervention model is both effective and easily implemented. This intervention should focus on women with a low income, women with low education levels, young women, migrant women, and women who have had multiple abortions or pregnancies.

Magnetic stimulation for stress urinary incontinence: study protocol for a randomized controlled trial.

BACKGROUND: There is currently a lack of randomized, sham-controlled trials that are adequately powered, using validated outcomes, to allow for firm recommendations on the use of magnetic stimulation for stress urinary incontinence. We report a protocol of a multicenter, randomized, double-blind, sham-controlled parallel-group trial to evaluate the efficacy of magnetic stimulation for stress urinary incontinence. METHODS/DESIGN: One hundred twenty subjects with stress urinary incontinence will be randomized in a 1:1 allocation to either active or sham magnetic stimulation using computer-generated, permuted blocks of variable sizes. Subjects will receive 2 sessions of magnetic stimulation per week for 8 weeks (16 sessions total). The primary outcome is the improvement in severity of involuntary urine loss based on the International Consultation on Incontinence Questionnaire for Urinary Incontinence Short Form at the end of treatment sessions compared with baseline. Secondary outcomes include cure, stress urinary incontinence-related symptoms (incontinence episode frequency, urine loss in 1-hour pad test, pelvic floor muscle strength) and health-related quality of life (Patient Global Impression of Improvement, International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life and EQ-5D). The safety of magnetic stimulation will also be assessed. Besides evaluation of clinical treatment effectiveness, cost-effectiveness analysis using patient-reported outcomes will be performed. DISCUSSION: This trial is designed to provide pending outcome information on this non-invasive treatment option. We intend to acknowledge the existing flaws in previous clinical trials and determine conclusively whether magnetic stimulation is effective for stress urinary incontinence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01924728. Date of Registration: 14 August 2013.

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.

Barriers in entering treatment among women with urinary incontinence.

OBJECTIVE: The aim of the study was to identify barriers in help seeking behaviors among women with urinary incontinence UI. MATERIALS AND METHODS: The study was performed using the method of diagnostic enquiry by means of questionnaire and interview among two groups of patients. The first group of women aged 47-79 years consisted of 80 members of the Association of People with Urinary Incontinence "Uroconti". The second group included 61 females aged 26-81 years admitted to the Urodynamic Laboratory of Gynecology and Oncology Clinic at the University Hospital in Krakow. RESULTS: Patients with stress urinary incontinence (SUI) reported to the doctor on average after 4 years, patients with urgency urinary incontinence (UUI), after 3 years, patients with a mixed form of urinary incontinence (MUI), after 6 years, and with overflow incontinence, after 10 years from the appearance of first symptoms. Anxiety shame, the conviction that symptoms of UI are a normal age related state, as well as the conviction that the symptoms are temporary significantly affected the delay in seeking medical consultation. Most of the surveyed women made the decision to undertake treatment themselves, and their main motive was the escalation of symptoms. The majority (89.4%) of women surveyed alleviated the symptoms of urinary incontinence without the help of a doctor sometimes using methods detrimental to their health. CONCLUSION: The identification of help seeking barriers and reaching out to risk groups is essential for early diagnose and effective treatment of women with urinary incontinence.

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.

Enhanced interpretability of the PFDI-20 with establishment of reference scores among women in the general population.

AIMS: To enhance the interpretability of the PFDI-20 by establishing a score distribution for women in the general population and to determine whether scores correspond with urinary and anal incontinence (UI and AI). METHODS: Subjects recruited during Twins Day Festivals from 2004 to 2009 completed a survey assessing for stress and urgency urinary incontinence (SUI and UUI) and AI of flatus and stool. Score distributions for the PFDI-20 and each of its subscales were determined for all subjects and for women with isolated forms of incontinence. Scores were compared between continent and incontinent women and between incontinent subtypes by Wilcoxon rank-sum tests. RESULTS: One thousand three hundred seventy-six women completed the survey with PFDI-20 (Median = 8.9, IQR 31.3), POPDI-6 (Median = 0, IQR = 8.3), CRADI-8 (Median = 0, IQR = 10.7), and UDI-6 (Median = 0, IQR = 16.7). PFDI-20, POPDI-6, CRADI-8, and UDI-6 scores were significantly greater among women reporting isolated SUI (P < 0.0001, P = 0.04, P < 0.0001, P < 0.0001, respectively), UUI (P < 0.0001, P = 0.02, P < 0.0001, P < 0.0001, respectively), mixed UI (P < 0.0001 each), AI flatus (P < 0.0001 each), and AI stool (P < 0.0001 each) compared to those denying incontinence. Women with mixed UI had significantly greater PFDI-20 and UDI-6 scores compare to those with SUI (P < 0.0001) or UUI (P < 0.0001). Subjects with AI stool had significantly greater PFDI-20 and CRADI-8 scores compared to those with AI flatus (P = 0.01). CONCLUSIONS: PFDI-20 scores from a sample of the general population correspond with the presence or absence of UI and AI. These normative and symptom-specific score distributions for the PFDI-20 provide reference points to gauge the effect of disease and intervention on quality of life for women with incontinence.

Correlation of three validated questionnaires for assessment of outcomes following surgical treatment of stress urinary incontinence in women.

OBJECTIVES: To assess the correlation between women's responses to the "Patient Global Impression of Improvement" questionnaire (PGI-I) and changes in women's quality of life and sexual function following surgical treatment of stress urinary incontinence (SUI). STUDY DESIGN: Ancillary analysis of data from a prospective randomised surgical trial: 299 women underwent transobturator tape insertion as a sole procedure and completed the King's Health Questionnaire (KHQ) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) at baseline and at 12-month follow-up in addition to PGI-I at 12 months. Spearman's correlation coefficient was used to evaluate the degree of association between PGI-I responses and the changes in total KHQ and PISQ-12 scores. Kruskal-Wallis tests were performed to compare the 7-point scale PGI-I responses in terms of changes in KHQ and PISQ-12 scores. RESULTS: There was a significant positive correlation between PGI-I responses and changes in the total KHQ scores (r=0.48, p<0.001). The changes in the total KHQ score became larger (i.e., more positive) as the PGI-I responses became more positive. There were statistically significant differences across the PGI-I groups with respect to the changes in total KHQ scores (p<0.001). "Very much improved/Much improved" responses on PGI-I were associated with median (IQR) improvement in KHQ scores of 46 (32, 60) and 35 (18, 49) points respectively. An 18-point improvement in total KHQ score was required to clearly indicate a "better" response on PGI-I. There was a statistically significant, but weak, positive correlation between PGI-I responses and the changes in the total PISQ-12 score (r=0.17, p=0.019). CONCLUSION: The Patient Global Impression of Improvement Questionnaire strongly correlates with changes in Kings Health Questionnaire scores following surgery for SUI and can reliably predict improvement and deterioration in women's quality of life. CONDENSATION: The Patient Global Impression of Improvement Questionnaire strongly correlates with, and can predict changes in, Kings Health Questionnaire scores following surgery for stress urinary incontinence.

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence.

OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence (SUI) through systematic review and economic modelling. DATA SOURCES: The Cochrane Incontinence Group Specialised Register, electronic databases and the websites of relevant professional organisations and manufacturers, and the following databases: CINAHL, EMBASE, BIOSIS, Science Citation Index and Social Science Citation Index, Current Controlled Trials, ClinicalTrials.gov and the UKCRN Portfolio Database. STUDY SELECTION: The study comprised three distinct elements. (1) A survey of 188 women with SUI to identify outcomes of importance to them (activities of daily living; sex, hygiene and lifestyle issues; emotional health; and the availability of services). (2) A systematic review and meta-analysis of non-surgical treatments for SUI to find out which are most effective by comparing results of trials (direct pairwise comparisons) and by modelling results (mixed-treatment comparisons - MTCs). A total of 88 randomised controlled trials (RCTs) and quasi-RCTs reporting data from 9721 women were identified, considering five generic interventions [pelvic floor muscle training (PFMT), electrical stimulation (ES), vaginal cones (VCs), bladder training (BT) and serotonin-noradrenaline reuptake inhibitor (SNRI) medications], in many variations and combinations. Data were available for 37 interventions and 68 treatment comparisons by direct pairwise assessment. Mixed-treatment comparison models compared 14 interventions, using data from 55 trials (6608 women). (3) Economic modelling, using a Markov model, to find out which combinations of treatments (treatment pathways) are most cost-effective for SUI. DATA EXTRACTION: Titles and abstracts identified were assessed by one reviewer and full-text copies of all potentially relevant reports independently assessed by two reviewers. Any disagreements were resolved by consensus or arbitration by a third person. RESULTS: Direct pairwise comparison and MTC analysis showed that the treatments were more effective than no treatment. Delivering PFMT in a more intense fashion, either through extra sessions or with biofeedback (BF), appeared to be the most effective treatment [PFMT extra sessions vs no treatment (NT) odds ratio (OR) 10.7, 95% credible interval (CrI) 5.03 to 26.2; PFMT + BF vs NT OR 12.3, 95% CrI 5.35 to 32.7]. Only when success was measured in terms of improvement was there evidence that basic PFMT was better than no treatment (PFMT basic vs NT OR 4.47, 95% CrI 2.03 to 11.9). Analysis of cost-effectiveness showed that for cure rates, the strategy using lifestyle changes and PFMT with extra sessions followed by tension-free vaginal tape (TVT) (lifestyle advice-PFMT extra sessions-TVT) had a probability of greater than 70% of being considered cost-effective for all threshold values for willingness to pay for a QALY up to 50,000 pounds. For improvement rates, lifestyle advice-PFMT extra sessions-TVT had a probability of greater than 50% of being considered cost-effective when society's willingness to pay for an additional QALY was more than 10,000 pounds. The results were most sensitive to changes in the long-term performance of PFMT and also in the relative effectiveness of basic PFMT and PFMT with extra sessions. LIMITATIONS: Although a large number of studies were identified, few data were available for most comparisons and long-term data were sparse. Challenges for evidence synthesis were the lack of consensus on the most appropriate method for assessing incontinence and intervention protocols that were complex and varied considerably across studies. CONCLUSIONS: More intensive forms of PFMT appear worthwhile, but further research is required to define an optimal form of more intensive therapy that is feasible and efficient for the NHS to provide, along with further definitive evidence from large, well-designed studies.

Concordance between one-hour pad test and subjective assessment of stress incontinence.

OBJECTIVES: To examine the concordance among the 1-hour pad test results, subjective questions regarding incontinence, and a quality-of-life questionnaire to assess the role of the pad test as a noninvasive measurement tool in clinical trials. The 1-hour nonstandard pad test is one of several quantitative tools used to measure urinary incontinence; however, its utility has been questioned. METHODS: The study subjects were women participating in 2 clinical trials evaluating noninvasive interventions: circular muscle exercises versus pelvic floor muscle training for urinary incontinence. The quantity of urinary leakage according to the pad test and questions regarding subjective urinary leakage from the quality-of-life questionnaire were evaluated for all study subjects combined and in subgroups. RESULTS: A total of 731 clinical pad tests were evaluated from the 2 trials. Significant associations were found between several questions regarding subjective leakage and the pad test results in the study subgroups. A significant correlation was seen between the pad test results and the quality-of-life questionnaire scores (r = 0.14 before intervention and r = 0.42 after intervention in the combined studies; P < .05). CONCLUSIONS: The 1-hour pad test demonstrated concordance with subjective assessment tools for urinary incontinence and should be considered a part of the armamentarium for assessing the severity of this condition.

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.

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.

Accuracy of recall in quality-of-life assessment among women operated on for stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The purpose of this study is to assess the validity and reliability of a retrospective quality-of-life (QOL) assessment. METHODS: The Incontinence Impact Questionnaire (IIQ-30) and the Short-Form Health Survey (SF-12) were self-administered pre-operatively. At 3 months post-op, the IIQ-30 and SF-12 surveys were mailed to patients to reassess their pre-operative QOL status. Pearson's correlation coefficient (r) and the intraclass correlation coefficient (ICC) were used to test the validity and reliability of the recalled IIQ and SF-12 scores. RESULTS: Recall validity was excellent for the IIQ-30 (r = 0.64) and moderate for the SF-12 (r = 0.46 (physical component summary or PCS) and 0.42 (mental component summary or MCS)). Recall reliability was moderate with the IIQ-30 (ICC = 0.62) and poor with the SF-12 (ICC = 0.44 (PCS) and 0.49 (MCS)). CONCLUSIONS: The IIQ-30 can be reliably used in a retrospective manner among women who have undergone surgery for SUI 3 months earlier.

Responsiveness of the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF).

This study aimed to evaluate the responsiveness of the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) in women undergoing surgery for pelvic floor disorders. Fifty-four women undergoing tension-free vaginal tape (TVT) and 47 women undergoing prolapse surgery completed ePAQ-PF at baseline and 3 months postoperatively. Responsiveness was calculated using effect sizes, standardized response means, responsiveness statistic, and minimally important difference. In the TVT group, the largest effect sizes were seen in the urinary domains for stress urinary incontinence (2.4), quality of life (2.2), and overactive bladder (0.9). In the prolapse group, the largest effect sizes were seen in the vaginal domains for prolapse (2.1) and quality of life (1.0). ePAQ-PF is responsive to change in women undergoing TVT or prolapse surgery in the salient and expected domains of stress incontinence and prolapse and quality of life and can be recommended for outcome measurement in this context.

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.

Female stress urinary incontinence: how do patient and physician perspectives correlate in assessment of outcomes?

PURPOSE OF REVIEW: This article discusses outcome assessment following surgery for incontinence, by correlating patient perspectives with that of the physician. RECENT FINDINGS: A review of the literature demonstrates a large variance in the 'success rates' published for different stress urinary incontinence procedures. We review the elements essential in formation of a universal and valid incontinence questionnaire. Studies have attempted to correlate common clinical measures (voiding diaries, pad testing, urodynamics) with quality-of-life questionnaires. Sentinel articles in incontinence outcome assessment are discussed. Studies with critical measures of outcome are examined using the recommendations made by the Female Stress Urinary Incontinence Guidelines Panel summary report. Through presentation of our data on tension-free vaginal tape procedures, we give insight into the future of stress urinary incontinence research and outcomes. SUMMARY: Early 'cure rates' were severely limited by their retrospective nature and focus on chart review and physician assessment. Symptom and quality-of-life questionnaires provide subjective outcome assessments. No direct correlation exists between universally accepted objective and subjective measures of improvement. Recent studies are getting closer to the female stress urinary incontinence guidelines. Yet, the pursuit for a universal definition of success continues, in order to bridge patient and physician perspectives on cure.

A survey of help-seeking and treatment provision in women with stress urinary incontinence.

OBJECTIVE: To establish the prevalence of treatment-seeking in women with stress urinary incontinence (SUI), the extent and type of treatment provision, and the levels of unmet need in women who have and have not accessed care, as SUI in women is common but only a small proportion seek help, and there are reports suggesting that few women receive appropriate treatment. SUBJECTS AND METHODS: A cross-sectional postal survey was conducted in which questionnaires were sent to a random sample of community-dwelling women aged > or = 40 years, registered with participating general practitioners (GPs) and living in Leicestershire. The questionnaires addressed urinary symptoms and their impact on quality of life, and service use in the preceding 12 months; 15 359 questionnaires were mailed and 9340 (60.8%) were returned complete. RESULTS: Of the respondents, 7.7% reported SUI monthly or more often, and 15% of those had sought help. Help-seekers reported more severe symptoms and greater impact on quality of life. Most (78%) had spoken to their GP, and 77% had received some form of treatment or advice, but only 35% had received recommended treatments. The effects on quality of life were not related to treatment provision. CONCLUSIONS: Most women with SUI are treated in primary care; access to appropriate treatments is poor and may, in part, be the cause of the high levels of unmet need observed in this study. Health education interventions may aid appropriate help-seeking and self-care strategies.