Results of a multicenter trial of the CapSure (Re/Stor) Continence shield on women with stress urinary incontinence

Dilemmas in the management of female stress incontinence: the role of pelvic floor muscle training

Treatment options for female stress urinary incontinence include pelvic floor muscle training, lifestyle interventions, bladder retraining, pharmacotherapy, anti-incontinence devices and surgery. Several consensus statements recommend pelvic floor muscle training as first line treatment. The aim of this review is to analyse all the currently available data and propose a treatment algorithm for clinical practice. A literature-based critical presentation of all treatment modalities, methods of assessing efficacy and comparison between them using a patient-centered approach was made. Many of the studies are observational, non-randomized with several methodological problems that lead to confusion. Emphasis was made to high quality randomized trials. The proposed treatment algorithm established only on evidence-based data. Management strategy however, must identify patient expectations and involve them in the decision-making more than traditional measures of treatment success.

Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review

This systematic review examined the use of incontinence-specific quality of life (QOL) measures in clinical trials of female incontinence treatments, and systematically evaluated their quality using a standard checklist. Of 61 trials included in the review, 58 (95.1%) used an incontinence-specific QOL measure. The most commonly used were IIQ (19 papers), I-QoL (12 papers) and UDI (9 papers). Eleven papers (18.0%) used measures which were not referenced or were developed specifically for the study. The eight QOL measures identified had good clinical face validity and measurement properties. We advise researchers to evaluate carefully the needs of their specific study, and select the QOL measure that is most appropriate in terms of validity, utility and relevance, and discourage the development of new measures. Until better evidence is available on the validity and comparability of measures, we recommend that researchers consider using IIQ or I-QOL with or without UDI in trials of incontinence treatments.

Compliance with recommendations of the urodynamic society for standards of efficacy for evaluation of treatment outcomes in urinary incontinence

The Urodynamic Society (US) published (1997) minimal standards to assess the efficacy of therapy for urinary incontinence (UI). The standards were developed by a US committee and were approved by the American Urological Society. The objective of our study was to evaluate compliance with these standards in recent UI research studies. A MEDLINE search was conducted for all articles in which outcomes of treatment for UI were reported (November, 1997-October, 1999). Reported data were compared with the recommended minimum standards including pre- and posttreatment data. Compliance rates for each data field were calculated by percentages for (1) the individual article and (2) overall compliance rate among all articles. A total of 39 articles that reported treatment for UI were selected. The treatments included various surgical procedures, injectables, pharmacologic treatments, and mechanical valves. Overall compliance for each article varied between 0% and 100%. Only one article met all 100% of the recommendations and one met none. The overall mean compliance rate for each article was 29%. We conclude that there is far less than optimal reporting of outcomes for treatment of UI per the recommendations of the Urodynamic Society. This low compliance makes standardized evaluation of treatment outcomes of UI difficult if not impossible. We suggest that initiation of funded cooperative clinical trials may improve the standardization in UI.

Questionnaires for women with urinary symptoms

AIMS

To identify the characteristics of optimal symptom questionnaires in women with lower urinary tract symptoms (LUTS).

METHODS

Literature review.

RESULTS

Although numerous questionnaires have been developed for the evaluation of female LUTS, no one instrument has emerged as that preferred for collecting and reporting subjective information about LUTS in women. Questionnaires currently available range widely in intended purpose, extent and style, and in the quality of testing used to validate them.

CONCLUSIONS

Questionnaires should be constructed based on scientifically sound validation techniques that reflect disease and/or symptoms in the target population. They should be concise, easily administered and scored, discriminant between sphincter and bladder causes of incontinence, and able to measure severity and the effect of the symptom on the patient.

Treatment of urinary incontinence

The treatment of urinary incontinence is a dynamic and evolving field. New therapies, techniques, and procedures, as well as some subtle refinements in treatments currently used, offer hope for the millions of people suffering from this condition. Recent attention has been directed toward reevaluating the efficacy and durability of some standard treatments for stress urinary incontinence, including pelvic floor exercise, bladder neck suspensions, and pubovaginal slings. Occlusive or supportive devices have evolved into a suitable alternative in some patients. Extracorporeal magnetic therapy and alternative periurethral injectable agents may offer additional treatment strategies for the relief of symptomatic stress urinary incontinence. New drugs for the treatment of overactive bladder and urge urinary incontinence have been introduced recently and, in combination with neuromodulation, offer the first new treatments for this condition in over 25 years. Yet, as rapidly as new therapies become available for the treatment of urinary incontinence, problems have become evident with some that were introduced just a short time ago. Thus, cautious skepticism regarding these "new and improved" treatments should be maintained until long-term data become available with respect to safety, efficacy, and durability.

Stress urinary incontinence

New techniques for the treatment of female stress urinary incontinence are constantly being developed. In assessing treatment modalities, one must consider many variables including patient satisfaction and quality of life, cure or improvement rate, patient selection, and long-term durability of results. In 1998, many papers comparing and examining the outcomes of various new and old techniques were published.