Recent developments in stress urinary incontinence in women.

This article provides an overview of stress urinary incontinence (SUI) and current treatments. The role of the specialist nurse is also explored. It is recommended that conservative treatment is offered to all women with SUI.

Treatments for stress urinary incontinence.

Stress urinary incontinence (SUI) is a common problem among women, particularly after childbearing. While it is not in itself life-threatening, it inevitably impairs quality of life, causing embarrassment and even social isolation--this is often both the reason that people with SUI seek medical help and the method of measuring the success of treatment. A range of treatment and management options is available for dealing with this distressing condition.

Outcome measures in urogynaecology: the clinicians' perspective.

There is currently a paucity of information regarding clinicians' expectations of treatment and whether their perception of bothersome symptoms is similar to that of the patient. Equally there is often a dichotomy of opinion when comparing clinician-centered evaluation with that of patients. The objectives of this study were to determine clinicians' expectations following treatment, to assess the methods of outcome assessment used in the clinical and research settings, and to compare clinician's expectations with those of patients. This was a prospective postal questionnaire-based study sent to members of the International Continence Society (UK). The questionnaire asked about expectations following treatment and use of outcome measures. These results were also compared to those of an identical patient questionnaire that have previously been published. Tests of agreement were performed between clinicians and patients using Cohen's kappa statistic. Two hundred ninety-nine questionnaires were distributed with a response rate of 52.7%. Overall, 85.9% of responding clinicians felt a good improvement in urinary symptoms, so that they no longer interfered with quality of life, was a realistic outcome. The majority of clinicians thought that small or infrequent episodes of leakage were acceptable following treatment, although frequent or large leaks were not. Irritative urinary symptoms such as urgency and urge incontinence were felt to be less acceptable as were the symptoms of frequency and nocturia. Overall, there was found to be poor agreement between clinicians and patients attitudes to acceptability of symptoms with values of kappa ranging from -0.103 to 0.105, indicating that this agreement was no better than chance. In the research setting, 61% felt both subjective and objective outcome measures should be used, whereas in clinical practice, 42% thought subjective improvement alone, and 36% subjective improvement in QoL, were appropriate. Clinicians have realistic expectations following treatment, although there is poor agreement with those expectations expressed by patients. These findings may help to explain why patients may be disappointed regarding treatment outcomes and why there may be a difference between subjective clinical impression of success and patient satisfaction. In addition there is a lack of conformity in the use of outcome measures in both the clinical and research settings.

Can ultrasound replace ambulatory urodynamics when investigating women with irritative urinary symptoms?

OBJECTIVE: To determine whether transvaginal ultrasound measurement of bladder wall thickness could replace ambulatory urodynamics when investigating women with lower urinary tract dysfunction not explained by conventional laboratory urodynamic studies. DESIGN: A blinded prospective study. SETTING: Tertiary referral unit in a London teaching hospital. POPULATION: One hundred and twenty-eight women referred for ambulatory urodynamics with equivocal laboratory urodynamic findings or whose symptoms were not explained by the laboratory urodynamic findings. METHODS: Transvaginal ultrasound assessment of bladder wall thickness was performed in three planes with an empty bladder prior to ambulatory urodynamics. Mean bladder wall thickness was calculated and the results analysed with respect to the ambulatory urodynamic diagnosis. MAIN OUTCOME METHODS: Mean bladder wall thickness in women with a normal ambulatory study or a diagnosis of detrusor instability, genuine stress incontinence (GSI) or mixed incontinence. RESULTS: Using a one way analysis of variance (ANOVA) bladder wall thickness was found to be significantly different in all diagnostic groups and this reached significance (P = 0.0001). There was no overlap in the 95% confidence intervals representing a diagnosis of detrusor instability or genuine stress incontinence. CONCLUSIONS: Transvaginal ultrasound assessment of mean bladder wall thickness is a sensitive screening tool, which can detect detrusor instability in those women with equivocal laboratory urodynamics. In women who have no evidence of GSI on laboratory studies, a cutoff of 6.0mm is highly suggestive of detrusor instability. However, in those women with GSI then ambulatory studies probably remain the investigation of choice.