Incontinence Modular Questionnaire Short Form Research Articles

Advanced Reconstruction of Vesicourethral Support May Improve Urinary Continence and Quality of Life After Non-nerve-sparing Robot-assisted Radical Prostatectomy.

Postoperative urinary incontinence (UI) after robot-assisted radical prostatectomy (RARP) has a significant impact on patients' quality of life (QOL). Several surgical techniques have been reported to improve postoperative UI. The aim of the study was to investigate the impact of advanced reconstruction of vesicourethral support (ARVUS) on urinary symptoms and QOL after non-nerve-sparing robot-assisted radical prostatectomy (RARP). Patients who underwent non-nerve-sparing RARP from October 2010 to October 2020 at the Division of Urology, Department of Surgery, Tottori University Faculty of Medicine were reviewed. Patients were divided into the ARVUS and non-ARVUS groups, and propensity score matching was performed. Patients were evaluated by the International Prostate Symptom Score (IPSS), Incontinence Modular Questionnaire Short Form (ICIQ-SF), QOL index, and number of pads used before and 1, 3, 6, and 12 months after RARP. The number of patients in the ARVUS and non-ARVUS group were 41 and 41, respectively. On cystography, the distance of the symphysis pubis to the bladder neck was significantly shorter (p<0.001) and the posterior urethrovesical angle was significantly smaller in the AUVUS group (p<0.001). In the ICIQ-SF, the ARVUS group was significantly better at 6 and 12 months postoperatively. In the IPSS, the ARVUS group was significantly better than the non-ARVUS group at 3 months postoperatively. In a multivariable analysis, membranous urethral length [odds ratio (OR)=3.44, p=0.015] and ARVUS (OR=2.72, p=0.046) were significant factors in achieving 0 pads and total ICIQ-SF Question 1 and 2 scores of ≤2 at 12 months postoperatively. ARVUS improved urinary symptoms and QOL. ARVUS seems to be a useful surgical procedure for non- nerve-sparing RARP.

Arabic (Tunisian) translation and validation of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7)

ABSTRACTObjective: To translate and validate an Arabic (Tunisian) version of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7), which can be used reliably in daily practice and clinical research for Tunisian and Arabic populations.Patients and methods: This cross-sectional study was conducted from January to June 2018. The UDI-6 assesses the presence of urinary incontinence (UI) and the degree of impairment that it causes, whilst the IIQ-7 evaluates women’s life quality with lower urinary tract symptoms. As UI is a relatively common condition in middle-aged and older women these tools are utilised worldwide. The Arabic (Tunisian) translation and cultural adaptation of the UDI-6 and IIQ-7 was achieved via the forward/backward method and comprehension test within a group of 15 patients. Psychometric validation included testing the questionnaire on a group of 35 patients. Intra-rater reliability was evaluated by calculation of the intraclass correlation coefficient (ICC) for each item of the questionnaires. Cronbach’s α was used to assess internal consistency. The International Consultation on Incontinence Modular Questionnaire short form (ICIQ-SF), in its Arabic version, was used as the ‘gold standard’.Results: For the UDI-6, the ICC was 0.98 demonstrating excellent intra-rater reliability and Cronbach’s α was 0.99 (>0.9), confirming an excellent correlation between the different items. Internal consistency (Cronbach’s α 0.99) and test–retest reliability of the IIQ-7 (ICC 0.98) were very good. For both questionnaires, the κ values for each item ranged from 0.77 to 0.96.Conclusions: We found that the UDI-6 and IIQ-7 questionnaires were valid tools that can be used reliably in daily practice and clinical research for Tunisian and Arabic women with UI.Abbreviations: ICC: intraclass correlation coefficient; ICIQ-SF: Incontinence Modular Questionnaire short form; IIQ-7: Incontinence Impact Questionnaire short form; QoL: quality of life; UDI-6: Urogenital Distress Inventory short form; UI: urinary incontinence

Vaginal therapy of mild and moderate stress urinary incontinence using Er:YAG laser: a real treatment option.

To evaluate the effectiveness of vaginal Er:YAG laser as treatment in patients with mild or moderate stress urinary incontinence. The study was a prospective, non-randomised, single center study of 33 women treated with two Er:YAG laser applications on an interval of four weeks. Follow-up evaluations were performed 4 and 8 weeks and 6 months after the first vaginal Er:YAG laser application (4 weeks and 5 months after the second vaginal Er:YAG laser application, respectively). The subjective outcomes were assessed using the International Consultation of Incontinence Modular Questionnaire Short Form (ICIQ-SF) and medical history. Patients rated their quality of life on a scale from 0 to 10. The average quality of life (QoL) showed a significant improvement 5 months after both Er:YAG laser applications. The mean QoL score was 6.0 (SD 2.4) and improved to a mean of 7.6 (SD 1.8) (p = 0.004). The mean ICIQ-SF score changed significantly from 12.3 (SD 3.2, median 13, range 8-18) before treatment to 6.8 (SD 4.0, median 7, range 0-15) 6 months after treatment (p <0.001). 24 patients out of 32 (75%) would again choose to have this therapy performed and 25 patients of 32 (78%) would recommend the vaginal Er:YAG laser therapy to a friend. The rate of side effects was low and none of the patients needed a medical treatment. This study confirms that vaginal Er:YAG therapy can improve clinical and quality of life outcomes in patients with SUI.

Urinary Symptoms in Multiple Sclerosis: Relation with Urodynamic Findings and Impact on Patient’s Quality of Life

Objective: We aimed to investigate the correlations of urinary symptoms with urodynamic findings in patients with multiple sclerosis (MS) and their effects on quality of life.Methods: Nineteen MS patients with urinary symptoms were included. The data were obtained from files or with face-to-face interviews. Symptom types of patients were categorized as irritative, obstructive, and mixed. The Incontinence Quality of Life Scale, the King’s Quality of Life Questionnaire (KQL) and the International Consultation on Incontinence Modular Questionnaire-Short Form were used to determine the effect of urinary symptoms on quality of life. The Extended Disability Status Scale (EDSS) was used to assess disability. All patients underwent urodynamic examination.Results: The most frequent finding in urodynamic testing was detrusor overactivity (57.9%) while 26.3% had normal urodynamics. EDSS score did not correlate with urinary symptoms or urodynamic findings; it correlated only with the “Role limitation” subscale of the quality of life scales. While there was no relationship between symptom type and quality of life, the rate of detection of pathological findings on urodynamic examination and the bladder capacity in patients with mixed-type symptoms were significantly higher than the patients with irritative symptoms (p&amp;lt;0.05). The ‘’Emotions’’ and ‘’Sleep/Energy’’ subscale scores of the KQL were significantly higher in patients with abnormal urodynamic test compared with those without urodynamic pathology.Conclusion: The urinary symptoms significantly affect the quality of life in MS patients. Since symptoms do not always correlate with the underlying pathology, it is more appropriate to give the treatment based on the bladder type in urodynamic testing.

The short-term effects of tolterodine on nocturnal incontinence after ileal orthotopic neobladder: a randomised crossover placebo-controlled study.

To assess the effect of tolterodine in the treatment of nocturnal urinary incontinence (NUI) after ileal orthotopic neobladder (ONB). This is a prospective randomised placebo-controlled crossover study (clinicaltrials.gov: NCT02877901). Patients with NUI after ONB were randomly allocated into two equal groups. Group T received 4mg extended-release tolterodine at bed-time and Group P received placebo for 4weeks followed by 2weeks of washout, then crossed over to the alternate therapy for 4weeks. Patients were assessed by the number of pads used per night (PPN) and with the Arabic version of the International Consultation on Incontinence Modular Questionnaire-Short Form (ICIQ-SF) at both phases of the study. The outcomes were the rate of NUI improvement and medication adverse events. Out of 172 patients, 150 and 122 patients were evaluated at both phases of the study. The mean ICIQ-SF scores and PPN were significantly decreased in Group T compared to Group P in both study phases (P<0.001). In Group T, 15 (10%) and 11 (9%) patients became dry after the first allocation and crossover, respectively. In Group T, 60 (77.9%) patients reported improvement vs four (5.5%) in Group P (P<0.001) after the first allocation. Similarly, 46 (73%) and seven (11.9%) patients showed improvement in groups T and P after the crossover, respectively (P<0.001). Dry mouth occurred in 31 (20.8%) patients. Tolterodine seems to be a good choice for treatment ofNUI after radical cystectomy and ONB. However,furtherstudies are needed to delineate the long-term effects and the associated urodynamic characteristics.

Male Sexuality, Fertility, and Urinary Continence in Bladder Exstrophy-Epispadias Complex

BackgroundThe bladder exstrophy-epispadias complex is a rare congenital malformation associated with severe dysfunction of the genital and urinary tracts and requiring a staged surgical reconstruction. AimThe primary aims of this study were to report the sexuality, infertility, and urinary incontinence outcomes in a cohort of men born with bladder exstrophy-epispadias complex. The secondary aim was to highlight some predictive factors of infertility in this population. MethodsWe conducted a descriptive, cross-sectional study of men diagnosed with classic presentations of bladder exstrophy or epispadias. OutcomesPatients were asked to complete 4 validated questionnaires: the International Index of Erectile Function (IIEF)-5, the Erection Hardness Score (EHS), the Self-Esteem and Relationship, and the International Consultation Incontinence modular Questionnaire-Short Form. Fertility potential was assessed with semen analysis and a non-validated questionnaire. Results38 Patients 18–64 years old (M [mean] = 32.2) completed the questionnaires. The average IIEF-5 score was 18.1/25 (ranging from 3–25; SE = 7.62), with results indicating that 55% of the sample had normal erectile function. Results also showed higher scores for patients with normal spermatozoa concentration (M = 22.75, SE = 1.89, P = .08) than for those with oligospermia (M = 17.30, SE = 8.53, P = .08). Results on the IIEF-5 also indicated higher scores for patients who conceived children without assisted reproductive technologies (ART) (M = 22.83, SE = 2.317, P = .02) than for patients without children (M = 15.76, SE = 8.342, P = .02). The average EHS was 3.43/4 (ranging from 1–4, SE = 0.9). EHS was higher for patients who had reconstruction than for patients who had cystectomy (M = 3.88, SE = 1.07 and 2.78, SE = 1.09, P = .02). The average total Self-Esteem and Relationship score was 67.04/100 (ranging from 10.71–96.43, SE = 22.11). The average total International Consultation Incontinence modular Questionnaire-Short Form score was 4.97/21 (ranging from 0–18, SE = 5.44), higher score indicating more urinary incontinence. Among the patients surveyed, 31.6% were parents at the time of study and 50% of them benefited from ART. With regards to the 14 semen analyses performed, only 7.1% produced normal results and 44.7% indicated that ejaculation was weak and dribbling. Clinical TranslationErectile function appears to be decreased and psychological aspects of sexuality indicate low self-esteem about sexual relationship. Although ethical problems could not allow prospective spermograms, our cohort is large enough to provide significant data. ConclusionsEarly sperm storage for future ART, sexual medicine management, and complementary genital reconstruction in adulthood constitute potential treatment options for this population.Reynaud N, Courtois F, Mouriquand P, et al. Male Sexuality, Fertility, and Urinary Continence in Bladder Exstrophy-Epispadias Complex. J Sex Med 2017;15:314–323.

Risk factors for stress urinary incontinence after native-tissue vaginal repair of pelvic organ prolapse.

To identify risk factors for postoperative stress urinary incontinence (POSUI) after native-tissue prolapse repair without a concomitant anti-incontinence procedure. The present single-center retrospective study included women with genital prolapse who underwent high uterosacral ligament suspension without a concomitant anti-incontinence procedure during 2008-2013. Univariate and multivariate analyses were performed to identify risk factors for POSUI (identified through clinical interview and International Consultation on Incontinence Modular Questionnaire-Short Form [ICIQ-SF] self-administration) at 6months. In total, 87 (20.9%) of 417 women developed POSUI. Preoperative stress urinary incontinence (SUI) and urodynamically diagnosed SUI were significantly associated with POSUI; moreover, women with POSUI had a higher preoperative ICIQ-SF score, a lower opening detrusor pressure, and a lower detrusor pressure at maximum flow than did women without POSUI (P<0.05 for all comparisons). In the multivariate analysis, preoperative SUI (odds ratio 3.11), a detrusor pressure at maximum flow of less than 30cm H2 O (odds ratio 2.93), and urodynamically diagnosed SUI (odds ratio 2.26) were independent risk factors for POSUI. Preoperative urodynamic parameters, obtained before prolapse repair surgery, were associated with POSUI and could be useful in providing adequate counseling to facilitate decision making on whether to add a concomitant anti-incontinence procedure.

The hybrid technique of pelvic organ prolapse treatment: apical sling and subfascial colporrhaphy.

The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy. This prospective study involved 148 women suffering from cystocele combined with apical prolapse. We used the following criteria to evaluate the results of surgical treatment: results of the vaginal examination (POP-Q system), urodynamic tests, bladder ultrasound, special questionnaires (Pelvic Floor Distress Inventory [PFDI-20], Pelvic Floor Impact Questionnaire [PFIQ-7], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12], International Consultation on Incontinence Modular Questionnaire Short Form [ICIQ-SF]). All listed parameters were determined before the surgery and at control examinations at 1, 6, and 12months after the treatment. At the 1-year follow-up, the objective cure rate for prolapse was 97.8%. The rate of anatomical recurrence was 2.2% (3 out of 138). The following long-term complications were noted: de novo urgency and stress urinary incontinence de novo in 2 (1.4%) and 4 (2.9%) patients, respectively. Comparison of the scores by the questionnaires also revealed a significant improvement in the quality of life in the postoperative period. Patient satisfaction rate was 97.1%. The hybrid technique is an effective and safe uterus-sparing method for patients with advanced forms of cystocele combined with apical prolapse. This technique improves voiding function, quality of life, and provides a high satisfaction rate.

Urge Urinary Incontinence And Pelvic Organ Prolapse Treatment By Cervicosacropexy (CESA): First Steps In Lithuania

Background. The purpose of our study is to evaluate and present the results of the first cervicosacropexy (CESA) in Lithuania, which was performed in Klaipeda university hospital. Materials and methods. For the 62 years old female patient suffering from overactive bladder syndrome, confirmed by urodynamic test, and II⁰ pelvic organ prolapse (by pelvic organ prolapse quantification classification) cervicosacropexy using polyvinylidene fluoride (PVDF) tape was performed in Klaipeda University Hospital in 2016. Urinary incontinence was evaluated by voiding diary, International Consultation on Incontinence Modular Questionnaire - Short Form (ICIQ-SF) and Overactive Bladder Symptom Score (OABSS), that were filled by the patient before the surgery and 2, 4, 8 weeks after it. Urinary urgency, episodes of urinary incontinence, the need of sanitary pads and urinary frequency were compared before and after the surgery. To assess urinary incontinence impact on daily life, the General King‘s Health Questionnaire (GKHQ) was used before and after the procedure. Results. After the surgery decrease of episodes of urinary incontinence, urinary frequency during day and night, urinary urgency and the need of sanitary pads were observed. Moreover, the patient could hold the urine longer after feeling the need to urinate. Scores of ICIQ-SF and OABSS decreased. GKHQ revealed considerable improvement in quality of life after CESA. Social life, mental and physical health of the patient were improved, and sexual life was unchanged. Conclusions. After CESA surgery using PVFD tape, functional indicators and quality of life were improved. First results of this surgery are very good and promising.

The impact of urinary incontinence on health-related quality of life (HRQoL) in a real-world population of women aged 45-60 years: results from a survey in France, Germany, the UK and the USA.

To develop a clear understanding of the relationship between severity of urinary incontinence (UI) and health-related quality of life (HRQoL) and mental well-being in a population of women of working age with the requisite demands of a busy, active life. A survey of women with UI, aged between 45 and 60 years, was conducted via the internet in the UK, France, Germany and USA between 1 and 30 September 2013. Validated outcome measures were used to assess symptoms and the impact of UI on activities of daily life, HRQoL, and mental well-being: The International Consultation on Incontinence Modular Questionnaire Short Form; (ICIQ-UI Short Form); the ICIQ-Lower Urinary Tract Symptoms Quality of Life; (ICIQ-LUTSqol); the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). The relationships between UI, HRQoL and mental well-being were analysed using analyses of variance and regression. The survey was completed by 1203 women with UI with an average age of 52.7 years. Based upon responses to the ICIQ-UI Short Form about the amount of urine that leaks, respondents were categorised as having light (n = 1023, 87%), medium (n = 134, 11%), or severe UI (n = 20, 2%). The scores on the ICIQ-UI Short Form increased with severity [mean (sd) scores: light UI 7.9 (3.4), medium UI 13.8 (2.9), and severe UI 18.3 (3.9)], as did the impact on HRQoL, assessed using the ICIQ-LUTSqol [mean (sd) scores: light UI 30.6 (7.3), medium UI 41.0 (11.2), and severe UI 56.9 (17.6)]. Mental well-being decreased with severity of UI, the mean (se) WEMWBS scores were: light UI 48.3 (10.1), medium UI 44.5 (9.5), and severe UI 39.9 (16.2). In women with UI, aged 45-60 years, UI symptoms directly affect HRQoL, which subsequently impacts negatively on mental well-being.

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.

Percutaneous Tibial Nerve Stimulation in Treatment of Overactive Bladder: When Should Retreatment Be Started?

To study the response to posterior tibial nerve stimulation in patients with overactive bladder refractory to medical treatment. A cohort of 53 patients were treated by posterior tibial nerve stimulation and followed up for a maximum of 24 months. All patients completed the International Consultation on Incontinence Modular Questionnaire-Short Form quality of life questionnaire and kept a urination diary to record the daytime urination frequency and night-time urination frequency. Urodynamic studies were also conducted. At 6 months of follow-up, a cure/improvement rate of 92.4% (49 of 53 cases) had been achieved. Ten patients were given additional treatment and were excluded from subsequent follow-up analysis. At 12 months of follow-up, a cure/improvement rate of 91.69% had been achieved (39 of 43). At 24 months of follow-up, of the 16 patients initially included during the first year, a cure/improvement rate of 62.5% had been achieved (10 of 16). The first sensation of bladder filling had increased by the end of treatment, with differences observed before and after posterior tibial nerve stimulation (P ≤ .001). The average post-treatment bladder capacity had increased by 72.7 mL compared with the initial value (P ≤ .001). At 24 months of follow-up, the group of 16 patients evaluated recorded a significant worsening of night-time urination frequency (P ≤ .05) and quality of life (P ≤ .01). Posterior tibial nerve stimulation is a good option for the treatment of overactive bladder. In our series, the optimal point to start retreatment would be at 24 months after therapy completion.

Evaluation einer Ambulanz für Harninkontinenz in Barcelona: Implementierung und Verbesserung der negativen Auswirkungen im Alltag, der Häufigkeit und des Schweregrades der Harninkontinenz

Urinary incontinence >(UI) is one of the most important and frequent geriatric syndromes. It is considered a silent but great social problem. Conservative management of UI, in a multidisciplinary and comprehensive approach, has been successful in previous studies, leading to a partial or total remission of the syndrome. To investigate the acceptance of a geriatric incontinence unit and the effect of a multidimensional intervention on the improvement of UI regarding frequency, severity and perceived impact on daily life of community-dwelling older adults. Prospective study with a multifactorial intervention with pre-post analyses. 92 patients aged 60 years and over were assessed for UI at an outpatient geriatric unit. They received an individualized conservative treatment and were followed up for 3 months. The International Consultation on Incontinence modular Questionnaire-Short Form (ICIQ-SF) was translated into Catalan. The difference of the perceived impact on the daily life before and 3 months after treatment was used as a primary outcome. The global score and the subscores on frequency and severity were used as secondary outcomes. 77.2% patients had an improvement in their perceived impact of UI on daily life. Concerning the ICIQ-SF global score, 82.6% improved. There was a significant improvement of about 30% in all dimensions measured. Many patients pointed out that being able to talk about the problem with a healthcare professional, in some cases for the first time, was very important to them. A conservative and multidisciplinary management of UI improved the impact of UI on daily life among comorbid geriatric patients. The Catalan ICIQ-SF was successfully implemented. Outpatient geriatric incontinence units seem to be effective and should be implemented to improve detection and management of this important geriatric syndrome.