ICIQ Score Research Articles

Étude prospective multicentrique randomisée évaluant l’intérêt de l’électrostimulation intravaginale à domicile après rééducation périnéale pour incontinence urinaire

ObjectivesIn order to maintain the benefits of perineal reeducation, patients with stress urinary incontinence need to perform self-retraining exercises of the perineal muscles at home. The aim of this randomized prospective multicentric study is to assess the effectiveness of GYNEFFIK®, a perineal electrostimulator, during this home-care phase. Patients and methodsTwo parallel groups of women with stress urinary incontinence (UI) or with mixed UI (composed predominantly of stress UI), improved by physiotherapy, have followed a self-reeducation program, either with electrostimulation sessions (GYNEFFIK® or home perineal electrostimulation [HPES] arm) or with usual care (UC) only, without electrostimulation. The comparison of the two groups was based on the rate of women in which the benefit of the initial perineal reeducation was maintained (defined as the ICIQ and Ditrovie scales’ score not worsening) at 2, 4 and 6 months. ResultsA total of 161 patients were analyzed (76 in the HPES arm and 85 in the UC arm). The therapeutic benefit of the initial perineal reeducation at the last available measure (6 months for a wide majority of patients) was maintained in 81.6% in the HPES arm versus 62.4% in the UC arm (P=0.007). This significant difference reflects a significant improvement both in clinical symptomatology and in quality of life. ICIQ score was improved in 44% of patients of HPES arm while it was improved in 14% of patients of UC arm (P<0.001) and daily number of urine leakage decreased of 1.2 leakage in the HPES arm versus 0.1 leakage in UC arm (P<0.05). Likewise, improvement of quality of life was superior in the HPES arm (48% improvement of Ditrovie score versus 19% in the UC group ; P<0.05). Discussion and conclusionInvestigator global impression was more favorable in the HPES arm (clinical improvement in 83% of patients versus 68% in the UC arm). At the last measure (i.e. endpoint), the benefit of initial physiotherapy was considered maintained or improved in all patients of the HPES arm while it was reported as worsened in 16.5% of the UC group. Using GYNEFFIK® favorably impacts quality of life, particularly physical activity and vitality and decreases emotional consequences of UI (i.e. anxiety and depression score as assessed by HAD scale).

Female sexual function after transobturator tape in women with urodynamic stress urinary incontinence

We evaluate quality of life and sexual function before and after transobturator tape procedure (TOT) using the International Consultation on Incontinence Questionnaire (ICIQ -SF) and Female Sexual Function Index (FSFI). Between 2008 and 2013, 92 patients with stress urinary incontinence (SUI) underwent TOT procedure. A total of 81 patients were sexual active and enrolled in the study. All patients completed the Turkish translation ICIQ -SF and FSFI forms before and 1, 3, 6, 12 months after surgery. To evaluate the impact of incontinence and TOT success on sexual function, we compared patients that were dry after surgery and patients still incontinent and/or facing complication.All 81 patients completed the study protocol. The total FSFI score was 21.3 ± 7.9 and statistically significant when compare with preoperative total FSFI score (16.2 ± 7.9). The mean postoperative ICIQ -SF score (2 ± 2.9) was also significantly lower than the mean preoperative ICIQ -SF score (17.3 ± 1.8). Complications were encountered in 13 patients, including vaginal erosion (4 patients), de novo urge incontinence (4 patients), vesico-vaginal fistula (1 case), cysto-rectocele (1 case) and high postoperative residue requiring mesh excision (3 patients). Continent (n = 68) patients had a significantly better postoperative total FSFI and ICIQ -SF score against patients who had urine loss.Our study found a significant improvement of FSFI score and ICIQ -SF score after TOT operation in women with SUI. Additionally, urine loss due to complications was related with worsened FSFI score and ICIQ score compare with healthy patient’s scores.

The effect of pelvic muscle exercises on urinary incontinency and self-esteem of elderly females with stress urinary incontinency, 2013.

Introduction:Millions of women are afflicted with stress urinary incontinence. Urinary incontinence is mentioned as one of the geriatric syndromes, together with pressure ulcers, functional decline, falls, and low self-esteem. The aim of the present study was to determine the effect of pelvic muscle exercises on urinary incontinency and self- esteem of elderly females with stress urinary incontinency in Shiraz, Iran, 2013.Material and Method:In this interventional study, 50 old females aged 60-74 years were chosen among the members of Jahandidegan center, and they were asked to sign the informed consent form and complete the demographic questionnaire. Then, Quid questionnaire was used for choosing the type of incontinence in the elderly females. Next, the participants completed the ICIQ and self-esteem questionnaires. Then, they were randomly assigned to case and control groups. Each participant took part in 8 training classes. Finally, the subjects filled the ICIQ and self-esteem questionnaires before and 2 months after the intervention.Result:The results is shown that after the intervention, ICIQ score has a significant difference between the two groups (P=0.001). Also, after the treatment, self-esteem average scores of studied unit indicated a significant statistical difference in experimental group. In other words, the training sessions improved the score of self-esteem in the experimental group (P<0.001) versus control group (P=0.08).Conclusion:Pelvic muscle exercises were an empowerment mechanism for incontinent women in improving their quality of life and self-esteem, so recommended that such these exercising programs be used in elderly health care centers as a factor to improve health promotion of elderlies ’that are suffering from urinary incontinence.

Third-line treatment for overactive bladder: should mirabegron be tried before intravesical botulinum toxin A therapy?

Mirabegron is a new beta 3 agonist for the treatment of overactive bladder (OAB). Although there are extensive data from randomised controlled trials, there is little real world evidence about its effectiveness and side effects. We conducted a prospective cohort study to evaluate the effectiveness of mirabegron as third-line treatment in patients with refractory OAB who did not benefit from antimuscarinic therapy and bladder drill. The study was a prospective consecutive cohort of 67 women treated with mirabegron 50 mg. All the patients had symptoms of urgency with or without urgency incontinence and had failed to improve with bladder drill and at least one antimuscarinic medication. The outcomes were assessed after 6 weeks using the International Consultation of Incontinence Modular Questionnaire Short Form (ICIQ-SF), Patient Global Impression of Improvement (PGI-I) scale and Kings Health Questionnaire (KHQ). The mean number of previous antimuscarinics was 2.81 (range 1-6). Forty out of 67 patients (60 %) described an improvement in their OAB. Responders demonstrated a significant improvement in 5 out of 10 domains of the KHQ. Similarly, the ICI-Q score improved from a mean of 12.7 (±5.3) to 9.2 (±5.3; p ≤ 0.008). Seven women (10 %) stopped mirabegron because of side effects. This post-marketing surveillance study confirms that mirabegron improves clinical and quality of life outcomes in patients with OAB. The rate of side effects was low. This study supports mirabegron use as a third-line treatment for overactive bladder.

Evaluation of urinary symptoms in patients with post-prostatectomy urinary incontinence treated with the male sling TOMS

To evaluate stress urinary incontinence (SUI), overactive bladder (OAB), and obstructive symptoms in patients with post-radical prostatectomy urinary incontinence (pRP-UI) treated with the bulbar compressive sling TOMS, and investigate the effect of each urinary symptom on urinary bother. We prospectively followed 40 patients with pRP-UI before, and 6 and 12 months (T6 and T12, respectively) after implantation of the TOMS sling. Urinary symptoms were evaluated using the following questionnaires: USP, ICIQ, UCLA-PCI (urinary bother domain), PGI-I, and daily pad use. Success was defined as patients wearing no pads or using one security pad. Significant improvement of mean USP-SUI (6.97/9, 3.35, 3.02, P < 0.001) and USP-OAB domains (8.1/21, 5.74, 5.71, P < 0.001), ICIQ (15.15/21, 8.17/21, 8.35/21, P < 0.01), urinary bother (92.5/100, 42.5, 41.87, P < 0.001), and pad number (2.78, 1.01, 1.03, P < 0.001) were noted between baseline, T6, and T12. At baseline, 32 (80%) patients reported urge incontinence. Urinary bother strongly correlated with UPS-SUI but not with UPS-OAB score. At T12, 22 (55%) patients with pad use were considered cured, and 13 (32.5%) patients reported a greatly improved urinary tract condition (PGI-I). Improvement of USP-SUI and USP-OAB scores correlated with improvement of ICIQ and PGI scores. The USP-obstructive domain remained unchanged. The TOMS sling improves SUI and OAB symptoms without generating obstructive symptoms. OAB symptoms including urge incontinence reported by most patients were not a major concern at baseline; however, improvement of these symptoms was associated with improvement of continence and PGI-I scores.

The two-year outcome of the I-Stop TOMS™ transobturator sling in the treatment of male stress urinary incontinence in a single centre and prediction of outcome

The aim of this study was to present the results of the 2 year outcome of I-Stop TOMS™ transobturator sling for post-prostatectomy (UIPP) minor to moderate male urinary incontinence treatment. A prospective, single center study, including 26 patients with minor to moderate IUPP and operated on using a suburethral sling (MS) TOMS™ (four arms) was performed. UIPP assessment was made preoperatively and 1 year postoperatively, using validated questionnaires (SF36 and ICIQ), number of pads daily, and the 24 hours Pad-test (LPT). Telephone follow-up evaluation was performed in 21 patients over a 2 years period following surgery. Radical prostatectomy was performed 48.4 months earlier and average patient age was 67.3 years. Preoperatively, the mean number of pads used daily was 2.3 with an average weight loss of 207.1grams at LPT. At 1 year, ICIQ and SF36 scores significantly improved. Weight loss in the LPT as well as the number of pads significantly decreased (P<0.05). At 1 year, 13 patients were cured, 12 were improved, one reached improvement criteria, and 96.2% using a pad daily maximum. With more than a 2 year follow-up, 10/21 patients were dry, nine improved and two failed, and 90.5% using 0 to 1 pad per day. The transobturator TOMS™ male sling is a simple and well-tolerated procedure permitting a significant improvement of UIPP, with 50% of patients achieving complete continence at 1 year postoperatively, these good results continued beyond 2 years. 4.

Differences in Geographical Distribution and Risk Factors for Urinary Incontinence in Turkey: Analysis of 6,473 Women

Objective: To assess the prevalence, types and risk factors for urinary incontinence (UI) and to evaluate the impact of incontinence on quality of life by using validated and objective questionnaires in the western and eastern parts of Turkey. Methods: In this multicenter observational study, 6,473 women from 38 cities in the western and eastern parts of Turkey were included. UI was assessed by ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form) and IIQ-7 (Incontinence Impact Questionnaire). Results: The UI rate was 20.9% (10% for stress, 8.3% overactive bladder and 2.6% for mixed type). In all, stress incontinence was the most common type. The rate of UI in women residing in the west was higher than in women living in the east (p < 0.001). ICIQ scores were comparable in the two groups but women in the west scored higher in each item of the IIQ. Age >40 years (p < 0.001), number of siblings >5 (p < 0.001) and low educational status (p < 0.001) increased the rate of incontinence. In binary logistic regression analysis menopausal status, age >40 years, number of siblings >5, being overweight, region of residence, and educational status were associated with UI. Conclusion: The rate of UI in women residing in the western part of Turkey was higher than women living in the east. Residing in a different geographical region (in our case living either in the western or eastern part of Turkey) seemed to be an independent risk factor for UI. Moreover, UI deteriorates quality of life and more attention should be paid to this vulnerable population.

Factors influencing women's participation in urogynecology research in the UK and USA

To explore factors influencing willingness to participate in urogynecology trials and explore associations between demographics, quality of life score (ICIQ-SF), and willingness to participate. The Bladder Clinic Questionnaire (BCQ) was developed, piloted, and validated. The BCQ and ICIQ-SF were distributed to women attending urogynecologists in tertiary referral centers in the UK and USA. The BCQ collected demographic data and data on previous involvement in research and posed eight research scenarios. Women were asked to record their willingness to participate on a Likert scale, collapsed for analysis into "any yes," "unsure," or "any no," giving a BCQ score between 0 and 16 (higher scores indicating greater willingness). Two hundred sixty-seven UK women and 200 US women returned completed questionnaires. Median BCQ score differed between UK and US women (11 [0-16] vs. 10 [0-16]; P = 0.004); median ICIQ score was similar (9 [0-21] vs. 9 [0-20]). ICIQ score was higher in UK women willing to participate in two scenarios: standard operation versus new operation (P = 0.007), and new operation versus new operation (P = 0.001). UK women were uniformly more willing to take part in all scenarios involving established treatments. We identified cultural differences in willingness to participate and differences depending on type of intervention proposed which supports the growing evidence that detailed pilot work is required during planning of intervention studies.

Can the Low Dose Antimuscarinics after Botulinum Toxin Type A (Dysport) Injection in Overactive Bladder Reduce the Probability of Reinjection?

Introduction: Dysport is used for the treatment of patients with OAB refractory to Anticholinergic drugs in recent years, but it needs to be reinjected after 6-9 months which results in spending more time and money and other reinjection problems. This study tries to find a way to reduce the probability of Dysport reinjection. Methods: Between 2008 and 2010, 35 patients with OAB refractory to oral treatment were included in before and after trials after ICIQ-UISF questionnaire filling , physical examination and urodynamic study. Then, all patients were injected 800 units Dysport in Detrusor muscle. Two weeks later, low dose prescription of Tolterodin tablet began. The outcome of the injection was evaluated and analyzed 6 and 12 month after the injection by using ICIQ-UISF questionnaire. Results: The patients were in the ages between 29 and 70. Twenty two patients suffered only from urge incontinency while 9 of them had mixed incontinency which showed that urge incontinency was more common. At the beginning of the study, the mean ICIQ score was 14.48-/+4.5 that reduced to +6 after 6 months. This score did not change after a period of 12 months.Conclusion: Mixed treatment i.e. the injection of Dysport and the low dose prescription of Tolterodin may reduce the probability of reinjection. However, further studies involving more patients seem to be necessary.

Effects of bariatric surgery on urinary and sexual function

To investigate the effects of weight loss and time post laparoscopic gastric banding surgery (LGB) on urinary and sexual function. 653 females and 145 males who underwent LGB over the last 10 years at a single centre in Australia were contacted by post and asked to complete validated questionnaires. The pre-surgery body-mass index (BMI) was higher in males than females (47.3 vs 43.5); 65% of the females and 24% of males previously had some degree of urinary incontinence (UI). There were significant weight and BMI losses in males and females (23.2 kg and 7.51 vs 22.7 kg and 8.28; P < 0.0001). In females there were significant improvements in the ICIQ-SF (P= 0.0008) and Quality of Life (P < 0.0001) scores. For each kilogram lost there was a 0.05 improvement in the ICIQ score (P= 0.03) in females. There were also postoperative improvements in all symptoms of UI and stress incontinence in females but urge incontinence worsened, when adjusted for weight loss. In males there was no improvement in UI with weight loss after LGB. There was no relationship with time and UI in either gender; 83.3% of males reported a degree of ED before LGB. There was improvement in the IIEF score in males post LGB but there was worsening of erectile index (P= 0.005) and orgasmic function (P= 0.002) when adjusted for time. More males had started using phosphodiesterase type 5 inhibitors, post-LGB. Surgically induced weight loss by LGB improved overall UI, quality of life and stress incontinence in females but urge incontinence worsened. There was no improvement in UI with weight-loss or overall sexual function after LGB in males. However, erectile index and orgasmic function worsened when adjusted for time. Further evaluation is required by means of larger prospective studies involving urodynamic testing.

IMPACT OF URINARY INCONTINENCE ON THE QUALITY OF LIFE AND FEMALE SEXUALITY

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence has a negative impact on quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%) overactive bladder (15%0) and mixed incontinence (26%) answered the ICIQSF (International Consultation on Incontinence Questionnaire &amp;ndash; Short From) and FSFI (Female Sexual Function Index) questionnaires before and after treatment. The follow up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectively (p&amp;lt; 0,001). Overactive bladder showed the worst scores in all domains. The patients underwent surgery to increase desire (p=0,02), satisfaction (p=0,05) and t otal score (p=0,02). In 13 patients the ICIQ score did not increase: desire (p=0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. A sexuality evaluation in incontinence patients is recommended.

Suffering in silence: pregnant women's experience of urinary incontinence in Zaria, Nigeria

Objective To determine the prevalence and severity of urinary incontinence during pregnancy in Zaria, Nigeria. Study Design This was a descriptive, cross-sectional study in which 204 apparently healthy pregnant women attending routine antenatal care (ANC) at the Ahmadu Bello University (ABU) Teaching Hospital in Zaria, Nigeria were screened for urinary incontinence using the International Consultation on Incontinence Questionnaire on Urinary Incontinence (ICIQ-UI Short Form) UK English Version. Nurses working in the antenatal clinic were trained on how to help respondents (most of whom were not literate) to respond to the questions. Uni- and bivariate analysis was performed on the data using SPSS version 15 for Windows. Results The prevalence rate of all types of urinary incontinence during pregnancy was 21.1% in the study population. Stress urinary incontinence was the most common type accounting for 60.5%. The majority of the expectant mothers (74.4%) reported leaking no more than once a week; in 90% of them the volume was small in amount. The modal ICIQ score for urinary incontinence was 3 for the study population. The majority (83.4%) of the incontinent women felt their symptom did not interfere with their daily routines. Conclusions About one-fifth of pregnant women in this setting experienced urinary incontinence which they did not report to their primary care providers. Awareness needs to be created for antenatal clients and providers on how to recognize symptoms and manage them. The ICIQ questionnaire has simplified this process.

Epidemiological aspects of urinary incontinence in a female population of an Italian region

The purpose of this study is to assess the incidence of female urinary incontinence (UI), risk factors, severity, and functional limitation using a cross-sectional survey in an Italian region. The method employed in this study was a questionnaire-based interview on non-institutionalized women. Outcomes were the UI prevalence, severity, associated factors, and functional limitation (ICIQ score). From October 2008 to February 2009, 1,346 women were interviewed and 15.3% were affected by UI. Univariate analysis found different risk factors, but multivariate analysis revealed only pelvic floor surgery, diabetes, vaginal deliveries, age, and educational level as significant. The involuntary loss of stools was more common in incontinent patients compared with healthy participants. The ICIQ values were significantly different between healthy and incontinent participants and a positive correlation existed with the estimated daily urine loss (r = 0.885, p < 0.001). Symptoms of UI affected a substantial proportion of the population investigated. Pelvic floor surgery, diabetes, and vaginal deliveries are the most significant risk factors implicated.

Evaluación de la función sexual femenina antes y después de un procedimiento para la corrección de la incontinencia urinaria de esfuerzo

The prevalence of urinary incontinence is around 20% of healthy middle-aged women. Incontinence causes a negative impact on the quality of life and sexuality. From August 2002 to January 2004, 30 patients (mean age 43 years) with stress urinary incontinence (59%), overactive bladder (15%) and mixed incontinence (26%) answered the ICIQ-SF(International Consultation on Incontinence Questionnarie-Short Form) and FSFI (Female Sexual Function Index) questionnaires before and after treatment for urinary incontinence. The follow - up ranged from 12 to 53 months. Mean ICIQ score was 17 and 7 before and after treatment respectivelly (p<0,001). Overactive bladder showed the worst scores in all domains. The patients who underwent surgery increased their scores of desire (p=0,02), satisfaction (p=0,05) and total score (p=0,02). Thirteen patients which ICIQ was zero increased: desire (p<0,01), satisfaction (p=0,05) and total score (p=0,01). Urinary incontinence significantly affects the quality of life. Therefore sexual evaluation in incontinence patients is recommended.