A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women

What do we do when a midurethral tape fails? Rediscovery of open colposuspension as a salvage continence operation

INTRODUCTION AND HYPOTHESIS

Our aim was to evaluate the outcome of open colposuspension for women with urodynamic stress incontinence who had previously undergone a failed midurethral tape.

METHODS

A retrospective study of 13 women who had undergone open colposuspension after a failed midurethral tape was conducted.

RESULTS

At a median follow-up of 12 months, subjective and objective cure rate were 85% and 77%, respectively. Thirty percent of the women developed de novo detrusor overactivity that responded to antimuscarinic treatment. Long-term voiding difficulty was observed in only one patient, who performed clean intermittent self-catheterization for 3 months. Posterior vaginal wall prolapse requiring pelvic floor repair was found in three women (23%) postoperatively.

CONCLUSIONS

Open colposuspension is an effective option for treating persistent or recurrent stress urinary incontinence after failed midurethral tape, with a high success rate.

Impact of Self-Perceived Bothersomeness on Health-Related Quality of Life in Women with Overactive Bladder Symptoms

INTRODUCTION

The objective of this study was to examine the impact of self-perceived bothersomeness of overactive bladder (OAB) symptoms on the health-related quality of life (QOL).

PATIENTS AND METHODS

A total of 92 women with a mean age of 53.3 (range 23-79) years suffering from OAB were included in the study. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and King's Health Questionnaire (KHQ) were used to assess the QOL. The patients were divided into two groups according to the bothersomeness degree of OAB: 'low' and 'moderate' to 'high'.

RESULTS

The SF-36 and the KHQ scores of the patients were significantly different from those of the controls (p <0.05), except for three domains of the SF-36. No difference in the results of the frequency-volume charts was observed between the two patient groups. The scores of the SF-36 and the KHQ domains did not correlate with the data of the frequency-volume charts. Significant differences were found between the two patient groups for most domains of the SF-36 (p <0.05). Significant differences were also detected in most domains of the KHQ (p <0.05).

CONCLUSIONS

Objective data are not a sensitive tool for measuring the QOL in women with OAB symptoms. Our findings suggest that patient-perceived bothersomeness significantly influences QOL and that strategies for assessing bothersomeness should be developed to evaluate the QOL in these patients.

Prevalence and outcomes of continence surgery in community dwelling women

PURPOSE

Published outcomes of continence surgery are based largely on cohort studies and a smaller number of randomized trials. There is no consensus on the outcomes that should be considered and patient reported outcomes have not always been included. We determined the prevalence of continence surgery as well as patient reported outcomes in community dwelling women.

MATERIALS AND METHODS

We performed a 2-stage national cross-sectional mailed survey. A short questionnaire used to identify women with a history of continence surgery was sent to 45,000 representative American households. Eligible women with a history of continence surgery received a followup questionnaire to assess patient reported outcomes, including current symptom frequency, bother and overall satisfaction.

RESULTS

Of the 24,581 women 967 (4%) had a history of continence surgery, including 73% who currently reported incontinence in the preceding month, 58% who reported incontinence in the preceding week and 53% who reported current use of pads or other absorbent material. Of those who reported incontinence 83% reported current stress incontinence symptoms, including 62% with stress and urge symptoms. A third of the women had been treated with surgery in the last 5 years. The proportion of women satisfied with the results of surgery decreased from 67% who recalled initial satisfaction to 45% who reported current satisfaction.

CONCLUSIONS

Almost 4% of women had undergone continence surgery and continence rates were lower than most published figures. However, some women reported satisfaction with surgery even when they did not achieve continence. Patient satisfaction and other patient reported outcomes might be considered with continence rates when determining surgical success rates.

The impact of urodynamic stress incontinence and detrusor overactivity on marital relationship and sexual function

OBJECTIVE

We assessed and compared the quality of life, marital relationship, and sexual function of women who had urodynamic stress incontinence (USI) or detrusor overactivity (DO) diagnosed.

STUDY DESIGN

Women with the following urodynamic diagnoses, normal, USI, or DO, were compared by using the psychometric questionnaires: King's Health Questionnaire (KHQ, for quality of life), Dyadic Adjustment Scale (DAS, for marital relationship), and Derogatis Sexual Functioning Inventory (DSFI, for sexual function).

RESULTS

Women with DO (n = 29) were younger than healthy women (n = 28) and women with USI (n = 36) (P <.05). Women with USI or DO had a poorer quality of life (P <.05), poorer marital relationship (P <.05), and less sexual satisfaction (P <.05), despite having no change in sexual drive (P >.05). Regression analyses showed that only sexual satisfaction and incontinence-related emotions were associated with marital relationship (P <.05).

CONCLUSION

Marital relationship and sexual function were negatively affected in women who had USI or DO.