The validation of international consultation on incontinence questionnaires in the Greek language

The Examination of the Relationship Between the Number of Births with the Symptoms of Urinary Incontinence and Low Back Pain Postpartum in Greek Women

BACKGROUND

Urinary incontinence and low back pain are often present during pregnancy and after childbirth. The aim of this study was to examine the relationship between the number of children with the occurrence of urinary incontinence and low back pain after pregnancy in the Greek population.

MATERIALS AND METHODS

Seventy-one Greek women (M = 35.0 age, SD = ±4.3) with specific inclusion criteria completed just once the International Consultation on Incontinence Questionnaire and the Oswestry Disability Questionnaire after five years from childbirth.

RESULTS

A total of 28.2% of the participating women experienced urinary incontinence, and 38% experienced low back pain after pregnancy. No relationship has been found between urinary incontinence and the number of births (r = 0.062, p = 0.609) and low back pain with the number of births (r = -0.076, p = 0.529). Statistically significant correlations were found between urinary incontinence and low back pain (r = 0.33, p < 0.01) and the urinary incontinence and the maternal age at first delivery (r = -0.264, p = 0.026) in women who underwent a vaginal delivery in second birth had fewer urinary incontinence symptoms and increased low back pain.

CONCLUSIONS

Few correlations emerged in the present study. Future research is necessary to be conducted to examine the relationship between postpartum women's demographic data, urinary incontinence, and low back pain.

Validation of Lower Urinary Tract Symptom Questionnaire in the Transmasculine Population

INTRODUCTION AND HYPOTHESIS

Transgender men and transmasculine individuals report a variety of lower urinary tract symptoms (LUTS), but little is known about LUTS in this population. One of the obstacles is the lack of validated questionnaires. This study was aimed at validating the International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms (ICIQ-LUTS), which measures filling, voiding, and incontinence symptoms, in transmasculine individuals.

METHODS

This is an observational validation study that included transmasculine individuals receiving care within a single tertiary care hospital system. Construct validity was assessed by comparing the ICIQ-LUTS with severity of LUTS as measured by the Urinary Distress Inventory-Short Form (UDI-6), and concurrent validity by the association between ICIQ-LUTS and the Patient Perception of Bladder Condition (PPBC). Discriminant validity was determined by comparing ICIQ-LUTS scores in those with and those without self-reported LUTS. Spearman correlation, t test, and Kruskal-Wallis test were used for data analysis.

RESULTS

A total of 131 respondents were included in the analysis. Only two individuals (1.5%) reported prior vaginectomy and/or phalloplasty. Concurrent validity was demonstrated by a significant association between ICIQ-LUTS subscales and PPBC (filling p < 0.001, voiding p < 0.001, incontinence p < 0.001). Construct validity was demonstrated by a significant correlation between ICIQ-LUTS and UDI-6 (filling ρ = 0.76, p < 0.001; voiding ρ = 0.48, p < 0.001; incontinence ρ = 0.61, p < 0.001). For discriminant validity, those with at least one self-reported LUTS had significantly higher (worse) ICIQ-LUTS subscale scores than those without self-reported LUTS.

CONCLUSIONS

The ICIQ-LUTS is valid for measurement of LUTS severity in transmasculine individuals. This will be an important tool to use in future research to learn more about LUTS in this population.

Lower Urinary Tract Symptoms in Greek Women After Menopause: The LADY Study

INTRODUCTION AND HYPOTHESIS

The genitourinary syndrome of menopause (GSM), apart from symptoms related to vulvovaginal atrophy (VVA), also consists of lower urinary tract symptoms (LUTS). Based on the common embryological origin of the genital and lower urinary system, the presence of estrogen receptors, and the high prevalence of VVA and LUTS in the menopausal population, the two conditions can coexist. This study is aimed at investigating the prevalence and risk factors of LUTS in a sample of Greek peri- and postmenopausal women.

METHODS

Four hundred and fifty (450) women, aged 40-70 years, attending three outpatient gynecology clinics for routine examination, completed a structured interview and responded to a validated questionnaire (International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms, ICIQ-FLUTS).

RESULTS

Urinary urgency or frequency affected 51.6% and dysuria 43.6% of the participants. Mild urgency or frequency was described by 25.6%, moderate by 14.4%, and severe by 11.6% of the women. Mild dysuria was reported by 26.26%, moderate by 5.8%, and severe by 11.6%. Age, weight, BMI, and number of pregnancies and abortions correlated with a higher ICIQ-FLUTS score. Women with moderate/severe symptoms of VVA, such as irritation, a burning sensation, and pruritus of the vulva or vagina, had a higher ICIQ-FLUTS score than women without such symptoms (beta coefficient 2.42, CI 1.204, 3.635, p < 0.001).

CONCLUSIONS

Lower urinary tract symptoms are very common among peri- and postmenopausal women and are linked to symptoms of VVA. Our data support the need for prompt evaluation of women transitioning to menopause, as these symptoms compromise the quality of life.

Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence-A Randomized Trial

IMPORTANCE

Urinary incontinence affects millions of women worldwide.

OBJECTIVE

The aim of the current study was to evaluate the efficacy and safety of periurethral platelet-rich plasma (PRP) injections in women with stress urinary incontinence (SUI).

STUDY DESIGN

This was a single-center, double-blind, randomized sham-controlled trial. Fifty participants with SUI and urodynamic stress incontinence were randomized in 2 equally sized groups. Women in the PRP group received 2 PRP injections at 3 levels of the urethra at 4- to 6-week intervals. Women in the sham group were injected with sodium chloride 0.9%. At baseline, participants underwent urodynamic studies and a 1-hour pad test and completed the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Patient Global Impression Scale of Improvement, and the King's Health Questionnaire. At follow-up visits (1, 3, and 6 months), women underwent the 1-hour pad test and completed the King's Health Questionnaire and the ICIQ-FLUTS. Primary outcome was the subjective evaluation as indicated by the response to question 11a of the ICIQ-FLUTS questionnaire. Secondary outcomes included scores of questionnaires and urine loss assessed on the 1-hour pad test. The level of discomfort during injections and any adverse events were also evaluated.

RESULTS

During follow-up, the mean score of the 11a question decreased significantly in the PRP group compared with sham. Subjective cure was significantly higher in the PRP group (32% vs 4%, P < 0.001). A significant reduction of urine loss assessed on the 1-hour pad test was observed in the PRP group compared with the sham group at 6-month follow-up. No adverse events were observed.

CONCLUSIONS

Periurethral PRP injections were superior to sham injections in improving SUI symptoms with an excellent safety profile.

Urdu translation and validation of the international consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS)

INTRODUCTION AND HYPOTHESIS

The International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) is a tool for the evaluation of lower urinary tract symptoms and their impact on the quality of life. The purpose of this research was the translation of ICIQ-FLUTS into the Urdu language and to determine its validity and reliability.

METHODS

Two bilingual translators translated the ICIQ-FLUTS Questionnaire into the Urdu language. Three experts compared the Urdu ICIQ-FLUTS with the original version of ICIQ-FLUTS. Urdu version was translated back into English by two translators. The pre-final version was drafted after tracking the forward and backward translation differences. The final Urdu version was drafted after application to ten patients (pilot study). Final Urdu ICIQ-FLUTS was applied to 120 participants for validity and reliability.

RESULTS

Urdu version was drafted after the consensus of the experts. The content validity index ranged between 0.81-0.93. The mean age of the participants was 45.2 ± 7.79 years. The test-retest reliability was analyzed through intraclass correlation coefficient (ICC) 0.972 and internal consistency by Cronbach's alpha 0.986. The concurrent validity was determined by correlating the ICIQ-FLUTS with ICIQ-UI SF (0.82) and UDI-6 (0.72).

CONCLUSION

It was concluded that the Urdu version of ICIQ-FLUTS is an assessment questionnaire for the signs and symptoms of urinary incontinence. It has good content validity, concurrent validity, and test-retest reliability.

Translation and validation of the international consultation on incontinence questionnaire-vaginal symptoms: the simplified Chinese version

INTRODUCTION AND HYPOTHESIS

International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) is a simple and effective questionnaire for evaluating vaginal symptoms, sexual problems and the quality of life (QOL) in patients. This study was aimed at validating the simplified Chinese version of the ICIQ-VS.

METHODS

A total of 120 women with pelvic organ prolapse (POP) stage <2, 124 with stage ≥ 2, and 51 patients who underwent POP surgery (POP stage ≥2) were included. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used for reliability analysis. We used the content validity index, Kruskal-Wallis H test, and Mann-Whitney U test to study validity. Paired sample t test, Wilcoxon signed-rank test, effect size and standardized response mean were used to assess sensitivity.

RESULTS

The Cronbach's alpha coefficients of the vaginal symptoms score (VSS) and sexual matters score (SMS) were 0.787 and 0.861 respectively. The test-retest reliabilities of the VSS, SMS, and QOL score were 0.830, 0.894, and 0.948 respectively. The test-retest reliability was from good to excellent (ICC 0.669-0.948). The item-level content validity index was 0.60 to 1.00. The scale-level content validity index/universal agreement was 0.95, and the scale-level content validity index/average was 0.96. Significant score differences existed between the symptomatic and asymptomatic groups (p < 0.001). Criterion validity was significant (p < 0.001). VSS and QOL score had high sensitivity (p < 0.001, effect size and standardized response mean >0.8).

CONCLUSIONS

The simplified Chinese version of the ICIQ-VS can objectively and reliably access vaginal symptoms, sexual matters, and QOL in Chinese women.

Translation and Validation of Bristol Female Lower Urinary Tract Symptoms Questionnaire for Urinary Incontinence in Urdu

Background

In this study, we aimed to translate and validate the 19-item version of the Bristol Female Lower Urinary Tract Symptoms (Bristol FLUTS) Questionnaire in Urdu among women experiencing urinary incontinence at a tertiary care hospital in Karachi, Pakistan.

Methodology

A cross-sectional validation study was conducted in the urology clinic at Aga Khan University Hospital, Karachi, Pakistan, between April and September 2021. After forward and backward translation of the Bristol FLUTS questionnaire, content validation was done by six experts, followed by the administration of the questionnaire to 10 respondents in the pilot phase of the study. In total, 207 participants were approached to fill the final version of the translated questionnaire. Overall, 188 respondents filled out the questionnaire, including 94 women with urinary incontinence and 94 women from the community to test construct validity. Finally, 30 women with urinary incontinence were asked to fill the form again two weeks later to determine test-retest reliability. Cronbach’s alpha was employed to assess the internal consistency of the questionnaire.

Results

The questionnaire displayed good content validity for reliability (content validity index: 0.84) and clarity (0.89). The scores reported by cases were significantly higher than the controls in all but the sexual function domain, suggesting good construct validity. Cronbach’s alpha of 0.81 signified good internal consistency, and a Pearson’s coefficient of 0.993 (p < 0.001) comparing responses at baseline and after two weeks indicated good test-retest reliability.

Conclusions

The Urdu translation of the Bristol FLUTS is a valid and reliable questionnaire that can be used in the clinical setting.

Translation and linguistic validation of the Persian version of the International consultation on Incontinence Questionnaire Vaginal Symptoms

Background:

There is no validated measurement tool to assess vaginal symptoms (VS), sexual matter (SS), and quality of life (QOL) among Persian-speaking women. This study aimed at translating and assessing the validity and reliability of the Persian version of the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (PICIQ-VS).

Materials and Methods:

In this cross-sectional study, after obtaining permission from the International Consultation on Incontinence Questionnaire (ICIQ) Advisory Board, the English version of ICIQ-VS was translated into Persian per a standard translate and back translate process, and the validity and reliability were studied. Two hundred women with and without pelvic organ prolapse were asked to complete the PICIQ-VS (mean age: 52.1, range: 22–84 years). A panel of 10 experts evaluated the content and face validity of the questionnaire. Cronbach's alpha examined the internal consistency reliability of the measure. To evaluate the test–retest reliability, we redistributed the questionnaire among 30 patients 2 weeks after their initial visit using intra-class correlation coefficient (ICC).

Results:

Content and face validity of the questionnaire was confirmed after some light modification (content validity ratio ranged from 0.69 to 1.00, and content validity index ranged from 0.79 to 1.00). PICIQ-VS showed an acceptable internal consistency and stability reliability (VS: α = 0.64, ICC = 0.84; SM: α = 0.69, ICC = 0.88; and total scale: α = 0.72, ICC = 0.91, respectively). Significant differences were observed between the asymptomatic and symptomatic groups for VS and the total score (P < 0.05).

Conclusion:

In the light of the results, interestingly, PICIQ-VS could be utilized as a valid and reliable tool to assess the VS among Persian-speaking women, both in research and clinical practice.

Polish versions of the ICIQ-FLUTS and the ICIQ-FLUTS LF: translation, adaptation, and validation of female-specific instruments for evaluation of lower urinary tract symptoms

INTRODUCTION AND HYPOTHESIS

Previously, there was no specific questionnaire in the Polish language for overall assessment of lower urinary tract symptoms (LUTS) in women. The aim of this study was to translate, culturally adapt, and validate Polish versions of the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS and ICIQ-FLUTS LF, short and long forms) for use in clinical practice and research in Poland.

METHODS

The original English ICIQ-FLUTS and ICIQ-FLUTS LF were adapted to Polish according to international standards and recommended procedures. Adult women with LUTS who were seen at the Department of Urology at the Jagiellonian University, Krakow, Poland, completed the ICIQ-FLUTS and ICIQ-FLUTS LF at baseline and 2 weeks later. Control participants completed the questionnaires once. Validity and reliability were determined.

RESULTS

One hundred and eighty Polish-speaking women who had LUTS completed the questionnaires. Content validity was high. Significant differences between women with LUTS and controls for both ICIQ-FLUTS and ICIQ-FLUTS LF confirmed optimal construct validity. An intercorrelation analysis revealed that internal consistency was good for ICIQ-FLUTS and ICIQ-FLUTS LF (Cronbach's alpha >0.7). Test-retest reliability (reproducibility) demonstrated strong stability (intraclass correlation coefficient > 0.7). Floor and ceiling effects were absent from women with LUTS, whereas a floor effect was detected in the control group.

CONCLUSIONS

The Polish ICIQ-FLUTS and ICIQ-FLUTS LF are valid, reliable, and consistent measures of overall evaluation of LUTS in women. They are equivalent to the original English versions, and they retained the psychometric properties of the original questionnaires.

Validation of the Thai version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS)

INTRODUCTION AND HYPOTHESIS

To provide a validated Thai language version of the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) following a standardized procedure and to evaluate its psychometric properties.

METHODS

After IRB approval, the English ICIQ-FLUTS was translated into Thai according to the cross-cultural adaptation process for patient-reported outcome measures. The psychometric properties of the final version of the Thai ICIQ-FLUTS were tested for content validity, internal consistency, construct validity, and test-retest reliability. Patients attending an urogynecology clinic and women from two communities were recruited for this study.

RESULTS

The final Thai version of the ICIQ-FLUTS was developed and assessed by a panel of clinicians fluent in both languages including the content expert. Women with and without female lower urinary tract symptoms (FLUTS), in whom the translation was pretested, agreed that the final version made sense and was understandable. Among the 288 women who received the questionnaires, 283 (142 attending the clinic and 141 living in the communities) returned the completed questionnaire. The overall internal consistency of the Thai-version questionnaire was high, with a Cronbach's alpha score of 0.849. Symptom scores for filling, voiding, and incontinence in patients attending the clinic were significantly higher than in individuals from the community (p < 0.001). The correlation coefficients between the test and retest among 136 participants for symptoms of filling, voiding, and incontinence were 0.925, 0.769, and 0.921, respectively (p < 0.05).

CONCLUSIONS

The Thai ICIQ-FLUTS contained satisfactory content and exhibited construct validity, internal consistency, and test-retest reliability. It is equivalent to the original English version and will be a valuable tool for assessing LUTS in Thai-speaking women.

Linguistic translation and validation of the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek menopausal women

OBJECTIVE

The objective of this study was to translate the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek and validate it for usage in the Greek population both in written and electronic form.

METHODS

The original English questionnaire MENQOL with 1-month recall period was translated by our team. According to instructions by Mapi Research Trust, the questionnaire was forward and back-translated, followed by patient testing and proofreading. Then it was transcripted electronically. Validation was performed with the following tests: internal consistency (reliability), stability (test-retest reliability) with Cronbach's alpha correlations, independent and paired t tests, and Pearson's correlation coefficients.

RESULTS

A total of 105 women, the majority recently menopausal, participated in the study. Internal consistency using the Cronbach's alpha showed high reliability ranging between 0.833 (physical domain) and 0.896 (vasomotor domain) for the written, and 0.720 (physical domain) and 0.868 (vasomotor domain) for the online form. Test-retest reliability was also high for both forms. The sexual domain of MENQOL had the higher mean, indicating the highest impact on quality of life (3.80 ± 2.35).

CONCLUSIONS

The Greek version of MENQOL is a reliable instrument for evaluating menopausal women. Availability of an online form will allow wider dissemination of the questionnaire. Further use of the questionnaire in Greece may lead to better understanding of the bothersome symptoms of menopause; a prerequisite to develop intervention studies for amelioration of quality of life.

Validation of the international consultation on incontinence modular questionnaire - female lower urinary tract symptoms (ICIQ-FLUTS) into brazilian portuguese

Purpose:

To translate, adapt and validate the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms ICIQ-FLUTS for the Brazilian female population.

Materials and Methods:

A translation of the questionnaire into Brazilian Portuguese was made followed by an adaptation for better understanding by native speakers. After that, the ICIQ-FLUTS was answered by eighty volunteers (n=80) twice (for interviewers 1 and 2) with an interval of 30 minutes between them. Furthermore, after 15 days from the evaluation, the participants answered the ICIQ-FLUTS again in order to verify the questionnaire stability over time. The questionnaires Utian Quality Of Life (UQOL) and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), which are validated in Brazil were also applied to perform the validation.

Results:

The result of the Cronbach α coefficient of the instrument presented a value of 0.832. The values for test-retest were 0.907 (inter-observer) and 0.901 (intra-observer). The correlation between ICIQ-FLUTS (score I - domain of urinary incontinence) with the ICIQ-SF (final score) was strong and positive (r=0.836, p=0.000). In addition, the ICIQ-FLUTS showed moderate and negative correlation with the total score of UQOL (r=-0.691, p=0.017).

Conclusion:

The Portuguese version of the ICIQ-FLUTS questionnaire showed strong correlation to ICIQ-SF questionnaire and satisfactory values to test-retest and internal consistency.

Women living with a midurethral sling in their 80s: long-term outcomes

INTRODUCTION AND HYPOTHESIS

Surgical outcomes of elderly women who have been treated using midurethral slings could be influenced by confounding factors, such as age-related comorbidities. Aim of this study is to assess elderly patients (>75 years) who underwent a transobturator sling procedure with a follow-up of at least 13 years.

METHODS

This is a prospective follow-up observational study including elderly women of current age ≥ 75 years old who underwent TVT-O placement at least 13 years prior to the study period. Main outcome measures were the objective and subjective cure rates at the follow-up visit. Secondary outcome measures included: patient-reported success rate, de novo urgency symptoms rate, evaluation of other subjective parameters related to the lower urinary tract function, and assessment of the health-related quality of life.

RESULTS

Seventy-two out of 85 women (84.7%) meeting the inclusion and exclusion criteria were assessed at the follow-up visit. The mean follow-up period was 13.7 years (SD = 0.8). The overall objective and subjective cure rates were 80.5% (58 out of 72) and 84.7% (61 out of 72) respectively, whereas 9.7% of the patients (7 out of 72) reported being subjectively improved. The patient-reported success rate was 91.7% (66 out of 72). De novo urgency rate was 23.7% (9 out of 38), whereas 26.5% of the patients (9 out of 34) reported aggravation of preexisting urgency.

CONCLUSIONS

In women of advanced age, the TVT-O procedure is a highly effective and long-lasting treatment. The safety profile of the TVT-O was not influenced by geriatric conditions, whereas the long-term presence of a polypropylene sling did not appear to trigger the onset of medical disorders.

Validation of the Turkish version of the International Consultation on Incontinence Questionnaire-vaginal symptoms (ICIQ-VS)

INTRODUCTION AND HYPOTHESIS

The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) was developed and validated in 2006 to evaluate vaginal symptoms, sexual matters, and quality of life of patients. This study aimed to validate the Turkish version of ICIQ-VS.

METHODS

The English version of the questionnaire was translated into Turkish. On the basis of the pelvic organ prolapse quantification (POP-Q) system, symptomatic women with ≥ 2 grade pelvic organ prolapse (POP) were included in the symptomatic (patient) group and asymptomatic women with ≤ 1 grade POP in the asymptomatic (control) group. The questionnaire was administered three times: after the first examination of the women (T1), 3 weeks after T1 (T2), and 3 months after the POP surgery (T3).

RESULTS

A total of 111 women were included in the study (symptomatic group, n = 53; asymptomatic group, n = 58). The missing data were ˂ 2%; the test-retest reliability was between 0.807 and 0.963, and the differences between the symptomatic and asymptomatic women were significant (p ˂ 0.001). A significant positive correlation existed between POP-Q and the vaginal symptom score, sexual matter score, and quality-of-life score (r_s = 0.844, 0.393, and 0.698, respectively; p < 0.001). The Cronbach's alpha was 0.72 for the vaginal symptom score and 0.73 for the sexual matter score. The sensitivity to change was significant (p ˂ 0.05). The effect size values of the vaginal symptom score, sexual matter score, and quality-of-life score were 2.55, 2.33, and 1.56, respectively.

CONCLUSION

The Turkish version of ICIQ-VS was successfully validated in this study, and a newer version of the questionnaire was made available for assessing vaginal symptoms, sexual matters, and quality of life of patients with POP.

Severe pelvic organ prolapse. Is there a long-term cure?

INTRODUCTION AND HYPOTHESIS

Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications.

METHODS

This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was "composite surgical success" defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp < 0) (anatomical success), (2) no vaginal bulge symptoms and (3) no re-treatment for prolapse recurrence.

RESULTS

The median follow-up was 7 years (range 3-10 years) with a composite surgical success rate of 95.7% (90/94). Failures (4.3%) included one (1.1%) case of anatomical recurrence (Bp: +1), one woman (1.1%) reporting vaginal bulge symptoms and two women (2.1%) who underwent a posterior colporrhaphy 6 and 12 months after primary surgery (reoperation rate: 2.1%). Two of 94 patients (2.1%) had been treated for mesh extrusion of the vaginal cuff prior to the follow-up visit.

CONCLUSIONS

The combined VALS technique can be considered a safe and effective procedure for the treatment of severe POP allowing a long-term anatomical restoration of all compartments with excellent functional outcomes.

Questionnaires to evaluate pelvic floor dysfunction in the postpartum period: a systematic review

Background

Pelvic floor dysfunctions (PFDs) affect the female population, and the postpartum period can be related to the onset or aggravation of the disease. Early identification of the symptoms and the impact on quality of life can be achieved through assessment instruments.

Objective

The purpose of this systematic review is to evaluate questionnaires used to assess PFD in the postpartum period.

Methods

A systematic review study was conducted, following Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) criteria, using the databases: PubMed, Biblioteca Virtual de Saúde (BVS), Web of Science, and Scopus, and the keywords PFD or pelvic floor disorders, postpartum or puerperium, and questionnaire. Articles published up till May 2018 were included, searching for articles using validated questionnaires for the evaluation of PFDs in postpartum women. The articles included were evaluated according to a checklist, and the validation studies and translated versions of the questionnaires were identified.

Results

The search of the databases resulted in 359 papers, and 33 were selected to compose this systematic review, using nine validated questionnaires to assess PFDs in the postpartum period: International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS), Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), PFDI-46, Pelvic Floor Impact Questionnaire (PFIQ-31), Pelvic Floor Bother Questionnaire (PFBQ), Female Pelvic Floor Questionnaire, electronic Personal Assessment Questionnaire – Pelvic Floor, and PFD questionnaire specific for pregnancy and postpartum. The most frequently reported questionnaires included PFDI-20, PFIQ-7, and ICIQ-VS and are recommended by ICI. In addition, the review identified a specific questionnaire, recently developed, to access PFD during pregnancy and postpartum.

Conclusion

The questionnaires used to evaluate PFD during postpartum period are developed for general population or urology/gynecology patients with incontinence and reinforce the paucity of highly recommended questionnaires designed for postpartum, in order to improve early and specific approach for this period of life.

Translation and validation of the International Consultation on Incontinence Questionnaire Vaginal Symptoms (ICIQ-VS): the Danish version

INTRODUCTION

In the clinical evaluation of women with pelvic organ prolapse (POP), it is important to evaluate both objective and subjective presentations. The objective evaluation is done by gynecological examination, but the subjective presentation is more complex. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) is an important tool for subjective evaluation, and a Danish version was developed.

MATERIALS AND METHODS

The English version was translated into Danish in accordance with guidelines. Eight women underwent a semistructured interview showing no misunderstandings. Women with and without prolapse completed the questionnaire and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. Three weeks later a retest was done. Women undergoing prolapse surgery completed the questionnaire 3 months postoperatively.

RESULTS

Ninety-four women with and 98 without prolapse were included; 52 underwent surgery. Retest response rate was 88-95%. Mean time between test and retest was 24.5 and 92.2 days, respectively. Missing data ranged between 0 and 1%. Test-retest reliability was good to excellent (ICC 0.61-0.88) and internal consistency was acceptable (Cronbach's alpha 0.79-0.84). The questionnaire was excellent when distinguishing between women with and without prolapse (p < 0.001). Criterion validity (correlation between POP-Q stage and the questionnaire) was perfect (p < 0.001). Sensitivity to change was excellent for vaginal symptom score and quality of life (p < 0.001) but not for sexual matters (p = 0.059).

CONCLUSIONS

The Danish version of ICIQ-VS was successfully translated and can be a valuable tool for prolapse research and daily evaluation of patients.

Reliability and Validity of the Persian Language Version of the Female Lower Urinary Tract Symptoms' Long form Questionnaire

Background:

Lower urinary tract symptoms (LUTS) are important and prevalent health problems that seriously affect many women and their quality of life (QOL). The female LUTS long form (FLUTS-LF) is a robust measure to assess the QOL of women. This study aimed at translating FLUTS-LF and assessing the reliability and validity of this questionnaire among Iranian patients with LUTS.

Materials and Methods:

Forward and backward translations of FLUTS-LF questionnaire were carried out by the research team. Data collection was conducted from November 2015 to March 2016 in Isfahan, Iran. A total of 237 women completed the Persian version of FLUTS-LF, incontinence QOL, and International Prostate Symptom Score (IPSS) questionnaires. We evaluated Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), stability (reliability), and confirmatory factor analysis (CFA) of the questionnaire.

Results:

The mean (standard deviation) age of the participants was 45.4 (12.50) years (range 20–70 years). Face and content validities were acceptable and missing data comprise 2% of the total data. Internal consistency (Cronbach's alpha) of the urinary symptoms was 0.78. ICC of the total score in urinary symptoms section was 0.95. Indexes of factor analysis were assessed and found to be acceptable. A high correlation was observed between the total scores of FLUTS-LF and IPSS.

Conclusions:

It seems that FLUTS-LF questionnaire can be a suitable instrument for assessing LUTS and their impacts on Iranian women's QOL.

Translation and validation of ICIQ-FLUTS for Tamil-speaking women

AIMS

Research in to lower urinary tract symptoms (LUTS) in women in South Asia is hampered by lack of validated tools. Our aim was to validate the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) from English to Tamil.

METHOD

After translation to Tamil, a validation study was carried out among women attending the gynecology clinic at District General Hospital-Mannar.

RESULTS

Content validity assessed by the level of missing data was <2%. Construct validity was assessed by the ability of the questionnaire to identify patients with incontinence (n = 45) from controls (n = 93) using the incontinence score [patients = 7.7 standard deviation (SD) = 4.7, controls = 1.4 SD = 2.2, p < 0.001] and those with symptomatic anterior wall prolapse (n = 16) from controls (n = 93) using voiding symptoms score (patients = 4.8 SD = 2.3, controls = 0.3 SD = 0.8, p < 0.001). Internal consistency was assessed using Cronbach's coefficient alpha score [0.80 (0.77-0.81)]. Test-retest reliability assessed by weighted kappa (κ) ranged from 0.73 to 0.87. Patients with incontinence (n = 30, pretreatment incontinence score = 7.9, SD = 4.9 versus posttreatment incontinence score = 3.3, SD = 3.1) and symptomatic anterior wall prolapse (n = 14, preoperative voiding symptoms score = 4.9 SD = 2.5 versus postoperative voiding symptoms score = 0.9 SD = 1.5) showed an improvement with treatment (Wilcoxon matched--pairs signed-rank test p < 0.001 and p < 0.01, respectively). An incontinence score ≥ 3 (sensitivity = 86.7%, specificity = 78.4%) and a voiding symptoms score ≥ 3 (sensitivity = 87.5%, specificity = 96.2%) detected any form of incontinence and symptomatic anterior wall prolapse, respectively.

CONCLUSION

Tamil translation of ICIQ-FLUTS retained the psychometric properties of the original English questionnaire and will be an invaluable tool to detect LUTS among Tamil-speaking women.

Microablative fractional CO2 laser for the genitourinary syndrome of menopause: power of 30 or 40 W?

This retrospective case-control study aimed to compare 30 versus 40 W power of CO₂ laser for the therapy of genitourinary syndrome of menopause (GSM). Postmenopausal women with severe intensity of dyspareunia and dryness were eligible to be included in this study. Primary outcomes were dyspareunia and dryness. Secondary outcomes were itching/burning, dysuria, frequency and urgency, Female Sexual Function Index (FSFI), vaginal maturation value (VMV), and Vaginal Health Index Score (VHIS). One laser therapy was applied every month for 3 months. Outcomes were evaluated at baseline and 1 month following the 3rd therapy. Fifty (25 per group) women were included in this study. In the 30-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.0 ± 1.9, 5.9 ± 2.0, 16.6 ± 6.7, 29.9 ± 13.0, and 11.0 ± 2.9, respectively (within group comparisons all p < 0.001). In the 40-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.5 ± 2.0, 5.2 ± 2.5, 14.8 ± 7.1, 25.0 ± 13.4, and 10.5 ± 4.1, respectively (within-group comparisons, all p ≤ 0.001). Comparison between 30 and 40 W revealed that mean improvement or presence of all GSM symptoms and clinical signs was not statistically significant different. CO₂ laser therapy may improve GSM symptoms and clinical signs. This improvement did not seem to associate to power of 30 or 40 W.

Microablative fractional CO2-laser therapy and the genitourinary syndrome of menopause: An observational study

OBJECTIVES

This study aimed to assess the effect of the Microablative Fractional CO₂ Laser (CO₂-laser) therapy on vaginal pathophysiology and the symptoms of the Genitourinary Syndrome of Menopause (GSM).

METHODS

Postmenopausal women with moderate to severe symptoms of GSM underwent three sessions of CO₂-laser therapy at monthly intervals. Participants were evaluated at baseline and 4 weeks after the last treatment.

MAIN OUTCOME MEASURES

The primary outcomes were Vaginal Maturation Value (VMV) and Vaginal Health Index Score (VHIS). Secondary outcomes included symptoms of GSM, Female Sexual Function Index (FSFI), International Consultation on Incontinence Questionnaire of Female Urinary Tract Symptoms (ICIQ-FLUTS) and Urinary Incontinence Short Form (ICIQ-UI SF), Urogenital Distress Inventory (UDI-6) and King's Health Questionnaire (KHQ).

RESULTS

Fifty-three postmenopausal women completed this study. VMV, VHIS and FSFI increased significantly. Dyspareunia, dryness, burning, itching, dysuria, frequency, urgency, urgency incontinence, stress incontinence and scores on the ICIQ-FLUTS, ICIQ-UI SF, UDI-6 and KHQ decreased significantly. Factors predicting for which women the CO₂-laser therapy was more effective were not identified.

CONCLUSION

This study suggests that intravaginal CO₂-laser therapy for postmenopausal women with clinical signs and symptoms of GSM may be effective in improving both vaginal pathophysiology and reported symptoms.

Occult Stress Urinary Incontinence in Women With Pelvic Organ Prolapse: Is the One Step Surgical Approach a Risky Choice?

OBJECTIVES

Occult stress urinary incontinence (SUI, OSUI) is defined as the demonstration of SUI after pelvic organ prolapse (POP) reduction. The aim of this study was to evaluate the effectiveness and complication rates of the 1-step surgical approach for treating women with POP and OSUI.

METHODS

Retrospective study of women with POP and OSUI who underwent a concomitant prolapse and midurethral sling procedure was conducted. Main outcome measures were absence of postoperative urodynamic stress incontinence (USI) and absence of postoperative SUI at 12 months. Secondary outcome measures included evaluation of objective and subjective parameters related to the lower urinary tract function and assessment of the quality of life.

RESULTS

Of the 244 women, 205 women (84%) attended the 12-month postoperative follow-up visit and were included in the study. Overall, 87.8% (180/205) of the patients had absence of postoperative urodynamic stress incontinence, whereas 95.1% (195/205) did not report postoperative SUI. Evaluation of parameters related to the postoperative lower urinary tract dysfunction showed that (a) 43% of women with preexisting urgency symptoms continued to have urgency, (b) 16.7% of patients presented de novo urgency, (c) de novo detrusor overactivity occurred in 9.3% of patients, and (d) 4.9% of women with preoperative obstructive voiding symptoms continued to have obstructive voiding symptoms after combined surgery. King's Health Questionnaire data analysis showed a statistically significant improvement in all domains.

CONCLUSIONS

This 1-step approach is both safe and effective and could be offered as a valid operative choice for those women who wish or should avoid a repeat surgical procedure for postoperative SUI.

The "1-3-5 cough test": comparing the severity of urodynamic stress incontinence with severity measures of subjective perception of stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

The purpose of the study was to examine whether a test performed during urodynamics, the "1-3-5 cough test", could determine the severity of urodynamic stress incontinence (USI).

METHODS

We included women referred for urodynamics who were diagnosed with USI. The "1-3-5 cough test" was performed to grade the severity of USI at the completion of filling cystometry. A diagnosis of "severe", "moderate" or "mild" USI was given if urine leakage was observed after one, three or five consecutive coughs respectively. We examined the associations between grades of USI severity and measures of subjective perception of stress urinary incontinence (SUI): International Consultation of Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptom (ICIQ-FLUTS), King's Health Questionnaire (KHQ), Urinary Distress Inventory-6 (UDI-6), Urinary Impact Questionnaire-7 (UIQ-7).

RESULTS

A total of 1,181 patients completed the ICIQ-FLUTS and KHQ and 612 completed the UDI-6 and UIQ-7 questionnaires. There was a statistically significant association of higher grades of USI severity with higher scores of the incontinence domain of the ICIQ-FLUTS. The scores of the UDI-6, UIQ-7 and of all KHQ domains (with the exception of general health perception and personal relationships) had statistically significant larger mean values for higher USI severity grade. Groups of higher USI severity had statistically significant associations with higher scores of most of the subjective measures of SUI.

CONCLUSIONS

Severity of USI, as defined by the "1-3-5 cough test", was associated with the severity of subjective measures of SUI. This test may be a useful tool for the objective interpretation of patients with SUI who undergo urodynamics.

Bladder and bowel symptoms among adults presenting with low back pain to an academic chiropractic clinic: results of a preliminary study

OBJECTIVE

The purposes of this study were to estimate the 1-month point prevalence of bowel and bladder symptoms (BBS) among adult chiropractic patients and to evaluate associations between these symptoms and low back pain (LBP).

METHODS

Patients 18 years or older presenting to a chiropractic college academic health clinic between March 25 and April 25, 2013, were asked to complete a symptom screening questionnaire. Descriptive statistics, binary logistic regression, Fisher exact test, and P values were calculated from the sample.

RESULTS

The sample included 140 of 1300 patients who visited the clinic during the survey period (11%). Mean age was 47.5 (range 18-79) years. LBP was the primary chief complaint in 42%. The 1-month point prevalence of any bladder symptoms was 75%, while the rate for bowel symptoms was 62%; 55% reported both BBS. Binary logistic regression analyses showed no statistically significant association between a chief complaint of LBP and combined BBS (OR = 1.67, P = .164).

CONCLUSION

The prevalence of bowel and bladder symptoms in chiropractic patients was high. There was no statistically significant association between these symptoms and LBP in this group of patients seeking care for LBP.

Midurethral slings for women with urodynamic mixed incontinence: what to expect?

INTRODUCTION AND HYPOTHESIS

We assessed the efficacy of midurethral slings (MUS) in women with urodynamically proven mixed incontinence (UMI).

METHODS

A prospective study was carried out in women with UMI in whom conservative treatment failed and who underwent MUS. Pre- and postoperative assessment included: completion of the validated ICIQ-FLUTS questionnaire, POP-Q examination and urodynamics (UDS). The primary outcome was the assessment of symptoms at 12 months. Secondary outcomes included assessment of postoperative UDS findings and evaluation of differences in symptoms and UDS diagnosis between the TVT and TVT-O groups.

RESULTS

Eighty-five women were included; 44 (49.2%) underwent TVT and 41 (51.8%) underwent TVT-O. Concomitant prolapse surgery was performed in 65 out of 85 patients (76.5%). At 12 months' follow-up there was a statistically significant reduction in stress urinary incontinence (p < 0.001), urge urinary incontinence (p < 0.001), urgency (p = 0.021) and frequency (p = 0.014). Depending on the symptom 10.6% to 24.7% of women reported deterioration of symptoms. UDS at 12 months revealed the absence of urodynamic stress incontinence (USI) in 82.4% of patients and no evidence of detrusor overactivity (DO) in 35.3%. No differences in symptoms were found between the TVT and TVT-O group, but the absence of DO was more common in the TVT group (48.5% vs 22.7%, p = 0.014).

CONCLUSIONS

Placement of MUS alleviates incontinence and overactive bladder symptoms in patients with UMI. TVT causes similar subjective improvement to TVT-O, but resulted in higher resolution of DO. Our study provides data that could be helpful in informing patients preoperatively of the potential impact that the MUS may have on each individual symptom separately, including the likelihood of symptom deterioration.