[Coital urinary incontinence. Associated symptoms and severity of incontinence]. / Incontinencia de orina durante la actividad sexual coital. Síntomas asociados y gravedad de la incontinencia.

INTRODUCTION: The objective of present study was to analyze the relationship between coital urinary incontinence (UI) and the symptoms of Stress UI (SUI), Urge UI (UUI) and the extent to which they impair the patient's life, measured through the ICIQ-UI SF questionnaire in a sample of sexually active women with UI symptoms. METHODS: Epidemiologic, observational, cross-sectional and multicentric study of 1,735 women with diagnostic of urinary incontinence (UI). Patients who were not sexually active were excluded, remaining 1,292 patients for the analysis. All women filled in the ICIQ-UI SF questionnaire and the King's Health Questionnaire (KHQ). RESULTS: According to KHQ, the prevalence of coital incontinence was 29.4%. Women with coital incontinence compared to those who did not suffer from it, had similar mean age and body mass index, were more likely to have symptoms of SUI (37.6% vs. 27.7%) and less likely to have UUI (16.6% vs. 27.4%) (p < 0.001). 36.1% of women with SUI had coital UI; this percentage was lower for women with UUI (20.1%). ICIQ-UI global score was higher in women with coital incontinence, 14.1 vs. 12.1 (p < 0.001), difference that was mainly due to the dimension "affectation" rather than "frequency" and "amount" dimension scores. DISCUSSION: Coital IU seem to be associated to SUI and to a higher severity of the urinary incontinence measured by the ICIQ-UI SF. Probably this association is due to the fact that ICIQ-UI-SF includes in its score the impact of patients' UI symptoms on their life and coital incontinence has an important effect on the quality of life of sexually active women.

Incontinencia de orina durante la actividad sexual coital. Síntomas asociados y gravedad de la incontinencia / Coital Urinary incontinence. Associated symptoms and severity of incontinence

Introducción: En el presente estudio se analizó en una muestra de mujeres sexualmente activas que consultaban por incontinencia urinaria (IU), la relación entre la IU en el coito y los síntomas de IU de esfuerzo y de urgencia y el grado de afectación por la IU expresados por la mujer mediante el cuestionario ICIQ-UI SF. Material y métodos: Estudio epidemiológico, observacional, transversal y multicéntrico de 1.735 mujeres con diagnóstico de IU. Las pacientes que no tenían relación sexual de pareja fueron excluidas siendo analizadas 1.292 mujeres, que cumplimentaron el cuestionario ICIQ-UI SF y el King’s Health Questionnaire (KHQ). Resultados: De acuerdo al KHQ, la prevalencia de IU en el coito fue de 29,4%. Las mujeres con IU en el coito en comparación a las que no la padecían presentaron similar edad media e índice de masa corporal, con mayor frecuencia síntomas de IUE (37,6% vs 27,7%) y con menor frecuencia síntomas de IUU (16,6% vs 27,4%) (p<0,001). El 36,1% de las mujeres con IUE referían IU en el coito, porcentaje que resultó inferior en las mujeres con IUU (20,1%). La puntuación total del ICIQ-UI SF fue superior en mujeres con IU en el coito, 14,1 frente a 12,1 (p<0,001), diferencia debida fundamentalmente a la dimensión “afectación” más que a “frecuencia” y “cantidad”. Discusión: La IU en el coito parece asociarse a la presencia de síntomas de IUE y a una mayor gravedad de la IU medidos por el cuestionario ICIQ-UI SF. Probablemente esta asociación se deba a que el ICIQ-UI SF incluye en su puntuación total la afectación causada por la IU y la IU en el coito tiene un importante efecto en la calidad de vida de las mujeres sexualmente activas (AU)

Introduction: The objective of present study was to analyze the relationship between coital urinary incontinence (UI) and the symptoms of Stress UI (SUI), Urge UI (UUI) and the extent to which they impair the patient’s life, measured through the ICIQ-UI SF questionnaire in a sample of sexually active women with UI symptoms. Methods: Epidemiologic, observational, cross-sectional and multicentric study of 1,735 women with diagnostic of urinary incontinence (UI). Patients who were not sexually active were excluded, remaining 1,292 patients for the analysis. All women filled in the ICIQ-UI SF questionnaire and the King’s Health Questionnaire (KHQ). Results: According to KHQ, the prevalence of coital incontinence was 29.4%. Women with coital incontinence compared to those who did not suffer from it, had similar mean age and body mass index , were more likely to have symptoms of SUI (37.6% vs. 27.7%) and less likely to have UUI (16.6% vs. 27.4%) (p<0.001). 36.1% of women with SUI had coital UI; this percentage was lower for women with UUI (20.1%). ICIQ-UI global score was higher in women with coital incontinence, 14.1vs. 12.1 (p<0.001), difference that was mainly due to the dimension “affectation” rather than “frequency” and “amount” dimension scores. Discussion: Coital IU seem to be associated to SUI and to a higher severity of the urinary incontinence measured by the ICIQ-UI SF. Probably this association is due to the fact that ICIQ-UI-SF includes in its score the impact of patients’ UI symptoms on their life and coital incontinence has an important effect on the quality of life of sexually active women (AU)

Coital urinary incontinence: impact on quality of life as measured by the King's Health Questionnaire.

The aim of this present study was to measure the impact of coital urinary incontinence (UI) on sexually active women quality of life (QoL). Epidemiological, observational, cross-sectional, and multicenter study including 633 sexually active women seeking treatment for UI and/or overactive bladder in a gynecological clinic, aged between 24 and 83 years. All women filled out the King's Health Questionnaire-KHQ. With this questionnaire, we had a complete register of the different urinary symptoms, included coital UI, and the extent of how they affect patient's life and the measurement of impact on the patient's QoL by the KHQ score. Prevalence of coital incontinence in sexually active women was 36.2%, classifying this impact as low (59.8%), moderate (32.3%), and high (7.9%). Women reporting coital incontinence had similar mean age and body mass index (BMI) to those women without coital incontinence. Women with coital incontinence had higher scores (worse QoL) in all the dimensions and in the KHQ global score (p < 0.05). Coital incontinence was the only variable showing an independent relation to KHQ global score (B = 10.1; 95% confidence interval = 1.7-18.6) in a multiple regression model adjusted to age, BMI, and the other urinary symptoms under study. One third of the sexually active women with urinary symptoms had coital incontinence. Among sexually active women with urinary symptoms, patients with coital urinary incontinence had a higher impact on their QoL than those without coital incontinence. Coital incontinence is independently related to a KHQ high score, which suggest worse QoL.

[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.

Determinación de las preferencias de las mujeres sobre el tratamiento de la incontinencia urinaria de esfuerzo mediante el método de la comparación de parejas / Evaluation of women preferences for the treatment of stress urinary incontinence using the paired comparisons method

OBJETIVOS: Conocer las preferencias de las pacientes con incontinencia urinaria de esfuerzo, para facilitar la toma de decisiones en la asignación de recursos y ayudar en la elección del tratamiento más adecuado. METODOS: Estudio transversal de 150 mujeres diagnosticadas de IU de Esfuerzo (IUE) en una Unidad especializada en IU. Todas fueron sometidas al protocolo diagnóstico de la Unidad. Se realizó una entrevista personal que incluía información sobre tres tratamientos para la IU (Reeducación Muscular del Suelo Pelviano-RMSP, fármaco y cirugía) y el «Cuestionario sobre preferencias» desarrollado por el método de la «comparación de parejas». Se construyó una escala «ranking» con las alternativas y se cuantificó la distancia entre ellas aplicando la «ley de los juicios comparativos». RESULTADOS: Las pacientes en conjunto prefieren el tratamiento con RMSP a las otras dos opciones, preferencia que se mantiene en el grupo de edad menor o igual a 46 años y en el de 56-62 años. Las pacientes entre 47 y 55 años parecen inclinarse por el tratamiento farmacológico. Las pacientes de edad mayor o igual a 63 años prefieren la cirugía. De acuerdo al nivel de gravedad, parece que en todos los niveles las pacientes prefieren el tratamiento conservador con RMSP, ocupando el segundo lugar el fármaco en las de gravedad moderada y severa. CONCLUSIONES: Las mujeres con IUE y que no han recibido tratamiento previamente, prefieren el tratamiento conservador con RMSP seguido del farmacológico y la cirugía (AU)

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 (AU)

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.

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

FUNDAMENTO Y OBJETIVO: El objetivo de este trabajo fue evaluar la sensibilidad para detectar cambios tras el tratamiento quirúrgico en mujeres con incontinencia urinaria tras la aplicación de la versión española del International Consultation on Incontinence Questionnaire-Urinary Incontinence ShortForm (ICIQ-UI) SF.PACIENTES Y MÉTODO: Estudio prospectivo de71 mujeres con incontinencia urinaria de esfuerzo (IUE) tratadas con banda vaginal libre de tensión. Se recogió en todos los casos el diagnóstico urodinámico de IUE y la puntuación del ICIQ-UI SF al entrar en el estadio y después del tratamiento quirúrgico para evaluarlo. RESULTADOS: Después del tratamiento, el 86%no tenía IUE según la urodinámica; ésta sólo fue normal en 45 (63,4%). Según el ICIQ-UISF, resultaron curadas 37 (52,9%). Las puntuaciones postratamiento fueron inferiores a las previas, las puntuaciones de las curadas fueron inferiores a las de las no curadas(p < 0,005). El acuerdo entre el ICIQUISF y la urodinámica fue moderado. CONCLUSIONES: El ICIQ-UI SF es sensible para detectar cambios tras tratamiento quirúrgico en mujeres con IUE

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 of71 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, 37patients(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

[Stress urinary incontinence: first cause of incontinence among women referred to an urogynecologic unit]. / Incontinencia de orina de esfuerzo: primera causa de incontinencia en las mujeres remitidas a una unidad de uroginecología.

OBJECTIVES: To analyze the distribution by symptoms, signs, and urodynamic diagnosis of women with urinary incontinence referred for study and treatment to the urogynecologic unit of a third level hospital. METHODS: Descriptive epidemiological study of 1713 consecutive women with symptoms of urinary incontinence referred for study and treatment to the urogynecologic unit between January 1998 and December 2002. Urogynecologic history, physical examination and urodynamic study were performed to all patients. Patients with genital prolapse greater than grade II were excluded. We analyzed the general characteristics of this group of patients, the distribution by main urinary symptoms, and the urodynamic diagnosis. RESULTS: Among 1732 patients complying with inclusion criteria, 1386 (80%) referred symptoms of urine loss with effort, 977 (56.4%) urgency incontinence, and 795 (45.9%) presented the association of both. 1175 patients (67.8%) presented symptoms of urine losses with effort associated to other symptoms suggestive of mixed UI (frequency, urgency, nicturia, or urgency UI). Urodynamic diagnosis of stress urinary incontinence was obtained in 782 patients (45.2%); detrusor hyperactivity was found in 290 (16.7%); mixed urinary incontinence 413 (23.8%); 142 patients (8.2%) were grouped under the concept of other diagnosis and 105 (6.1%) had a normal study. CONCLUSIONS: Stress urinary incontinence is the most frequently referred symptom in patients with symptoms of incontinence without symptomatic genital prolapse. In most cases it is associated to other urinary symptoms suggestive of mixed UI. The urodynamic diagnosis of stress urinary incontinence is the most frequent in this kind of patients.

[Validation of the Spanish version of the International Consultation on Incontinence Questionnaire-Short Form. A questionnaire for assessing the urinary incontinence]. / Validación de la versión española del International Consultation on Incontinence Questionnaire-Short Form. Un cuestionario para evaluar la incontinencia urinaria.

BACKGROUND AND OBJECTIVE: A big proportion (40-70%) of patients with urinary incontinence (UI) do not ask for medical advice. Self-administered questionnaires may help in detecting UI. The objective of the present study was to validate the Spanish version of the questionnaire ICIQ-SF. PATIENTS AND METHOD: 500 women who consulted at a UI-specialized unit responded to the questionnaire. A urodynamic study was carried out and sociodemographic and clinical data were collected. Feasibility, validity and reliability were assessed. Sensitivity (Se), specificity (Sp) and positive (PPV) and negative (NPV) predictive values of the clinical and urodynamic study were also calculated. RESULTS: The mean time of administration was 3.5 (1.5) minutes. All patients answered all the items of the ICIQ-SF. According to the clinical diagnosis, patients with UI scored 11.6 (5.9) and patients without UI scored 4.5 (6.3) (p < 0.001). According to the urodynamic diagnosis, UI patients scored 11.1 (6.3) vs 6.2 (6.5) (p < 0.001). In patients with an urodynamic diagnosis of stress UI, a higher severity degree was associated with a higher score on the ICIQ-SF. The values of Se, Sp, PPV and NPV were 92.1%, 55.6%, 88.3% and 65.9%, respectively, regarding clinical diagnosis, and 87.7%, 40.8%, 85.1% and 46.2%, respectively, regarding the urodynamic study. CONCLUSIONS: This is the first questionnaire designed for diagnosing UI validated in Spain. The psychometric properties of the ICIQ-SF are satisfactory and allow to recommend the use of the questionnaire in the clinical practice.

Clinical, urodynamic, and manometric findings in women with combined fecal and urinary incontinence.

AIMS: To determine the prevalence of fecal incontinence in patients with urinary incontinence, who were referred for urodynamic evaluation, and to compare clinical and manometric findings between double incontinence and isolated fecal incontinence. METHODS: Nine hundred women with urinary and/or fecal incontinence were prospectively investigated. Patients with double incontinence (group 1) were compared with 38 women with isolated fecal incontinence (group 2). Clinical data regarding obstetric and urogynecologic history, bowel habit, and type of fecal incontinence were collected. Urodynamics and anal manometry were performed. RESULTS: Seventy-eight patients (8.7%) presented double incontinence. A history of vaginal delivery and chronic straining was more frequent in patients with double incontinence (P=0.043). No differences were found in the severity of fecal incontinence. Physical examination showed a greater prevalence of rectocele (54% vs. 12%) in group 1. On urodynamics, 80% of women with double incontinence had stress urinary incontinence. Rectal sensation testing revealed a significantly higher rate of hyposensitivity in group 2 (22% vs. 43%). CONCLUSIONS: This study supports a close association between combined stress urinary and fecal incontinence, history of vaginal delivery, and chronic straining.