Urogenital Distress Inventory Scores Research Articles

Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence.

BackgroundCurrent research focuses on three variables in evaluating the impact of stress urinary incontinence (SUI) on daily living: severity of incontinence, distress or bother resulting from incontinence, and effect on health related quality of life (HRQoL). Understanding the impact of these variables is important as they are the driving force behind women seeking surgical treatment. Given the importance of HRQoL in determining need for treatment, as well as evaluating treatment success, this review provides an assessment of the degree to which HRQoL is impaired in women seeking surgical treatment.MethodsPubMed searches for the terms "quality of life and distress and urinary incontinence" and "quality of life and bother and urinary incontinence" were performed with limits of English, human and female subjects through May 2008. All studies using validated instruments were included. No time limit was placed on the search.ResultsOf 178 articles retrieved, 21 met the inclusion criteria, and 17 reported methods of scoring. The studies used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Wide ranges of mean and individual levels of severity of symptoms, UDI and IIQ scores were seen among women seeking surgical treatment. Fourteen studies reported baseline and post-surgical treatment distress and QoL data. Statistically significant improvements between baseline and post-surgical UDI and IIQ scores were reported in 12 studies. Reported cure rates ranged from 46% to 97%. Satisfaction with the procedure was reported in 4 studies and ranged from 84% to 91%. A minority of studies reported the relationship between reduction in symptoms and change in HRQoL.ConclusionHRQoL is the main reason women seek surgical treatment for incontinence and surgical treatment leads to a significant improvement in mean HRQoL scores. Assessment of HRQoL has proved less useful in identifying why individual women seek treatment for incontinence. Preliminary work has begun to characterize the interaction between severity of symptoms, distress or bother resulting from these urinary symptoms, impact on HRQoL, and treatment seeking behavior, but further research is needed. Greater standardization in the reporting of results of distress or bother and HRQoL would allow for comparison across studies.

Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling?

Our purpose was to determine if women with mixed urinary incontinence (MUI) and urodynamic detrusor overactivity (DO) have less improvement in urinary symptoms after pubovaginal sling surgery (PVS), compared to MUI without DO. Women with preoperative MUI symptoms prior to PVS were identified through retrospective review. DO was defined as a symptomatic 5 cm H20 detrusor pressure or greater rise during urodynamics. MUI patients with and without DO before PVS were divided into Groups A and B, respectively. All patients had returned a completed Urogenital Distress Inventory 6 (UDI-6) questionnaire and a 3-day diary of pad usage before surgery and at each postoperative visit. Study endpoints included change in total UDI-6 score, and change in number of pad use/day after PVS. 73 patients were identified, 31 in Group A and 42 in Group B. Mean follow-up after PVS was 15 and 16 months, respectively (p = 0.59). Preoperative total UDI-6 scores were 11.8 and 12.7 (p = 0.30) for Group A and B. Mean changes in total UDI-6 after PVS were - 8.0 and - 10.2 (p = 0.030), respectively. After PVS, both groups reported similar mean reduction in pad/day usage from preoperative baseline (-2.57 vs. --2.49, p = 0.83). There were no differences between the groups when comparing demographic, urodynamic, or operative data. MUI patients had improved continence and quality of life after PVS. However, MUI patients with DO had less improvement in UDI-6 scores after PVS, despite a similar reduction to pad use/day.

An interviewer-administered validated female pelvic floor questionnaire for community-based research

The aim of this study was to design and validate an interviewer-administered pelvic floor questionnaire suitable for community-dwelling women to assess female bladder, bowel, and sexual function; pelvic organ prolapse; and condition-specific quality-of-life issues. The questionnaire was developed and administered during interviews of 493 community-dwelling women aged 40 to 79 years originally recruited from an age-stratified random sample from the electoral roll who were involved in a longitudinal study of aging in women. Full psychometric testing was performed. To assess discriminant validity, 55 consecutive patients attending a tertiary referral urogynecology clinic served as a comparison group. Face validity: The interviewer-administered questionnaire was easily administered and missing data did not exceed 2%. Discriminant validity: The questionnaire clearly discriminated the community population from the urogynecology patients in all pelvic floor domains. Convergent validity: The bladder function domain score correlated with the validated short version of the Urogenital Distress Inventory score. Bowel function scores correlated highly with corresponding items in an established bowel questionnaire. Prolapse symptoms correlated significantly with the pelvic organ prolapse quantification. Sexual function score (n = 257) correlated with the validated McCoy Female Sexuality Questionnaire score. Reliability: Cronbach's alpha for the bladder, bowel, prolapse, and sexual function domains was adequate (alpha >or= 0.7). Kappa values in the test-retest analyses varied between 0.63 and 1.0 (test-retest reproducibility). The interviewer-administered questionnaire assesses all aspects of pelvic floor function including condition-specific quality-of-life issues in a reliable and valid fashion. It is suitable for researchers investigating pelvic floor function.

Surgical Versus Nonsurgical Treatment of Women With Pelvic Floor Dysfunction: Patient Centered Goals at 1 Year

In women with pelvic floor dysfunction we assessed the degree to which treatment (surgical vs nonsurgical) was associated with achievement of patient centered goals, satisfaction with care and quality of life. In this prospective cohort study between September 2003 and December 2004 we recruited women during their first referral visit for pelvic floor dysfunction treatment at our outpatient Urogynecology Clinic. At the first visit women enumerated up to 5 personal treatment goals, and anchored each goal by anticipating best and worst possible outcomes. At 12-month followup women were asked to indicate the level of goal attainment (-2 worst outcome, +2 best outcome). At baseline and followup women completed short forms of the Incontinence Impact Questionnaire and Urogenital Distress Inventory (range 0 to 100, high scores indicating greater impact or distress). Patients indicated the level of treatment satisfaction on a 4-level ordinal scale. Of the 127 study participants with complete data 46 (36.2%) were treated surgically and 81 (63.8%) were treated nonsurgically. There were no major demographic differences between the 2 groups in terms of age, race, weight, prior pelvic floor dysfunction surgery and vaginal parity. The surgical group was more likely to have received a baseline diagnosis of pelvic organ prolapse (80% vs 60%, p = 0.0259) and be postmenopausal (89% vs 72%, p = 0.0261). There were no significant differences in the distribution of goal type (symptom relief, activity, self-image, general health) by treatment status (p = 0.1074). Using logistic regression to adjust for age and baseline diagnosis, surgically treated patients at 1 year were significantly more likely to report complete primary goal attainment (OR 4.42, p = 0.0154) and complete treatment satisfaction (OR 6.12, p = 0.0109). For all participants 1-year Incontinence Impact Questionnaire-7 and Urogenital Distress Inventory-6 scores were significantly correlated with primary goal attainment scores. In this nonrandomized, prospective analysis surgically treated patients with pelvic floor dysfunction had higher 1-year self-described complete goal attainment and satisfaction scores compared with patients treated nonsurgically. Goal attainment scores correlated with disease specific quality of life. Patient centered outcomes should be incorporated in multicenter prospective research trials for pelvic floor disorders and in clinical practice to inform treatment plans.

Symptomatic Uterine Fibroids: Treatment with Uterine Artery Embolization or Hysterectomy—Results from the Randomized Clinical Embolisation versus Hysterectomy (EMMY) Trial

To prospectively evaluate health-related quality of life (HRQOL) outcomes for uterine artery embolization (UAE) and hysterectomy up to 24 months after the intervention in terms of mental and physical health, urinary and defecatory function, and overall patient satisfaction. Ethics committee approval and informed consent were obtained for the Embolisation versus Hysterectomy Trial. Women (n = 177) with uterine fibroids and heavy menstrual bleeding who were scheduled to undergo hysterectomy were randomly assigned to undergo UAE (n = 88) or hysterectomy (n = 89). HRQOL was measured six times during a 24-month follow-up period with the following validated questionnaires: Medical Outcome Study Short Form 36 (SF-36) mental component summary (MCS) and physical component summary (PCS), Health Utilities Index Mark 3, EuroQol 5D, urogenital distress inventory (UDI), incontinence impact questionnaire, and defecation distress inventory (DDI). Satisfaction was assessed with a seven-point Likert scale. Repeated measurement analysis was performed for between-group analysis. Paired t tests were performed for within-group analysis. Satisfaction was analyzed with the Fisher exact test. The SF-36 MCS and PCS, Health Utilities Index Mark 3, EuroQol 5D, and UDI scores were improved significantly in both groups at 6 months and afterward (P < .05). The DDI score was improved significantly in only the UAE group at 6 months and afterward (P < .05). No differences between groups were observed, with the exception of PCS scores at 6-week follow-up: Patients in the UAE group had significantly better scores than did patients in the hysterectomy group (P < .001). Improvement in PCS score at 24-month follow-up was significantly higher for patients who were employed at baseline (P = .035). At 24-month follow-up, patients in the hysterectomy group were significantly more satisfied than those in the UAE group (P = .02). Both UAE and hysterectomy improved HRQOL. No differences were observed between groups regarding HRQOL at 24-month follow-up. On the basis of HRQOL results, the authors determined that UAE is a good alternative to hysterectomy.

Preliminary Report on a Modified Surgical Technique Using Canal Transobturator Tape for the Treatment of Female Stress Urinary Incontinence

Purpose: Canal transobturator tape (TOT) was developed to reduce the complications of TOT by modifying the sling procedure of TOT with using a distal urethral polypropylene sling (DUPS). The aim of this present study was to describe a modified surgical technique for the treatment of female urodynamic stress urinary incontinence and to assess the objective and subjective efficacy of Canal TOT. Materials and Methods: Between October 2006 and November 2007, 87 female patients with stress urinary incontinence were enrolled in this retrospective study. All the patients underwent the Canal TOT procedure. The Incontinence Impact Questionnaire-7 (IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6) were used to evaluate the surgical outcomes. Results: The mean operative time for Canal TOT was 22.4 minutes (range: 15-39). During the surgery, there were 10% intraoperative and postopreative complications, including De novo urgency (n=3), weak stream (n=4) and difficult emptying (n=2). Yet all these complications occurred in the short-term and they were transient. Concomitant procedures were performed, including cystocele repair (n=7), rectocele repair (n=5), rectocele and cystocele repair (n=14), laparoscopically-assisted vaginal hysterectomy (n=5) and total vaginal hysterectomy (n=1). The average follow-up was 4.5 months (range: 3-12). Both the mean IIQ-7 and UDI-6 scores significantly decreased after Canal TOT and all the patients showed significant improvement of their subjective symptoms of stress incontinence. Conclusions: Our results demonstrate that Canal TOT may be a safe and effective surgical method for treating urodynamic stress incontinence in Korean women and this procedure provides a high cure rate. (Korean J Urol 2008;49:1119-1124) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Randomised trial of laparoscopic Burch colposuspension versus tension‐free vaginal tape: long‐term follow up

To compare the long-term efficacy of laparoscopic Burch colposuspension with tension-free vaginal tape (TVT) for the treatment of urodynamic stress urinary incontinence (SUI). Long-term follow up from a prospective randomised trial. Academic tertiary referral centre. Seventy-two women with urodynamic SUI from two institutions. Subjects were randomised to either laparoscopic Burch or TVT from August 1999 to August 2002. Follow-up evaluations occurred 6 months, 1 year, 2 years, and 4-8 years after surgery. Subjects completed the Incontinence Severity Index, Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient Global Impression of Improvement (PGI-I) scales. Median follow-up duration was 65 months (range 12-88 months) with 92% completing at least one follow-up visit. Seventy-four percent of subjects had long-term (4-8 years) follow up. Fifty-eight percent of subjects receiving laparoscopic Burch compared with 48% of TVT subjects reported any urinary incontinence 4-8 years after surgery (Relative Risk (RR):1.19; 95% CI: 0.71-2.0) with no significant difference between groups. Bothersome SUI symptoms were seen in 11 and 8%, respectively, 4-8 years after surgery (P = 0.26). There was significant improvement in the postoperative UDI-6 and IIQ-7 scores in both groups at 1-2 years that were maintained throughout follow up with no significant differences between the groups. TVT has similar long-term efficacy to laparoscopic Burch for the treatment of SUI. A substantial proportion of subjects have some degree of urinary incontinence 4-8 years after surgery; however, the majority of incontinence is not bothersome.

Race and ethnicity do not contribute to differences in preoperative urinary incontinence severity or symptom bother in women who undergo stress incontinence surgery

The purpose of this study was to determine whether race/ethnicity affects urinary incontinence (UI) severity and bother in women who undergo surgery for stress incontinence. We used baseline data from participants in the Stress Incontinence Surgical Treatment Efficacy trial. UI severity was measured by the number of leakage episodes during a 3-day urinary diary and by urodynamic evaluation. UI bother was measured with the Urogenital Distress Inventory. Race/ethnicity classification was based on self-report. Of the 654 women, 72 women (11%) were Hispanic; 480 women (73%) were non-Hispanic white; 44 women (6.7%) were non-Hispanic black, and 58 women (8.9%) were of other race/ethnicity. No differences were seen in any UI severity measures. Non-Hispanic white women had the lowest Urogenital Distress Inventory scores on bivariate analysis, which was explained by socioeconomic status, body mass index, and age on multivariate analysis. Factors other than racial/ethnic differences underlie variations in UI symptoms and bother in this group of women who sought surgery for stress incontinence.

Urinary incontinence in women with gynecologic malignancies before and after primary therapy

9087 Background: There is limited data on the impact of treatment for gynecologic cancer on future urinary incontinence. Our objective is to determine degree of urinary incontinence in women previously treated for gynecologic cancer and women not yet treated. Methods: With IRB approval gynecologic cancer patients that had completed therapy over 1 year prior and those not yet receiving therapy were asked to participate. Consenting subjects completed the Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI). Both are scored from 0–100 with higher scores representing more incontinence. We also assessed general health. Mean scores were calculated and compared with adjustments for covariates. In established patients Kruskal-Wallis was used to test overall equality of IIQ and UDI across various diagnoses and treatments. Results: Ninety new patients and 104 established patients were enrolled. Age, parity, tobacco use and use of incontinence medications were similar between the groups. General health status was worse in the new patients (p&lt;0.0001). Mean (± S.E.) IIQ scores were similar between new (6.87 ± 1.4) and established patients (4.76 ± 0.96), p=0.56. Mean UDI scores were also similar for new (17.2 ± 9.0) and established (13.2 ± 9.8) patients, p=0.20. After adjusting for health status, parity, age, tobacco use, prior use of incontinence medications there was no significant difference in either score. There was a significant positive association between age and incontinence as assessed by IIQ (p=0.02). We compared scores for established patients diagnosed with cervical, ovarian, uterine and vulvar cancer and found no significant difference in either IIQ (p=0.55) or UDI (p=0.76). Similarly there was no significant difference in scores for patients receiving hysterectomy, radical hysterectomy, BSO, vulvectomy, tumor debulking, chemotherapy or radiation therapy. Although not significant there was a trend toward more incontinence in patients having received radical hysterectomy. Conclusions: Urinary incontinence as measured by IIQ and UDI dose not appear to be different at the time of diagnosis of gynecologic cancer and a year from the completion of therapy. There is no apparent difference in urinary incontinence across diagnoses. No significant financial relationships to disclose.

Long‐term patient satisfaction following cadaveric pubovaginal sling incontinence surgery using the UDI and IIQ‐7 questionnaires

The goal of any incontinence surgery is overall long-term patient satisfaction. The purpose of our study was to assess long-term patient satisfaction following cadaveric fascia lata pubovaginal sling surgery using the urogenital distress inventory (UDI) and the short form of the incontinence impact questionnaire (IIQ-7). A total of 47 patients who underwent pubovaginal sling incontinence surgery with a minimum follow-up of 2 years were sent by mail the UDI (total score = 300) and the IIQ-7 (total score = 100). Thirty-seven responses (78.7%) were obtained, with a mean follow-up of 3.8 years (range 2.0-6.2). Of the 37 patients who responded, the mean UDI score was 75.8 and the mean IIQ-7 score was 21.4. There was no difference in the mean IIQ-7 score for patients with more than 4 years follow-up as compared to the entire group (28.8, P = 0.22). In contrast, the mean UDI score for patients with more than 4 years follow-up was greater compared to the entire group (99.1, P = 0.04). UDI subscale analysis revealed that patients mainly complained of both irritative and stress symptoms as opposed to obstructive/discomfort symptoms (P < 0.01). Patients with pre-operative mixed incontinence had greater mean UDI and IIQ-7 scores compared to patients with pre-operative pure stress incontinence (96.7 vs. 58.0, P = 0.04; 32.5 vs. 11.9, P = 0.03). Overall long-term scores assessing quality of life (IIQ-7) were good and those assessing symptom distress (UDI) were satisfactory following pubovaginal sling surgery. Patients with pre-operative mixed incontinence are at greatest risk for post-operative dissatisfaction.

Outcomes with porcine graft placement in the anterior vaginal compartment in patients who undergo high vaginal uterosacral suspension and cystocele repair

The purpose of this study was to prospectively assess the cases of patients who had undergone a high uterosacral suspension and anterior repair with anterior compartment placement of porcine dermis graft. Thirty-six patients who underwent transvaginal high uterosacral suspension and cystocele repair with graft augmentation from June 2001 to July 2004 were identified from the University of Alabama at Birmingham Genitourinary Disorders database. Analysis included the pre- and postoperative Pelvic Organ Prolapse Quantification examinations and incontinence impact questionnaire-7/urogenital distress inventory-6. Mean Pelvic Organ Prolapse Quantification Ba improved from +3.3 +/- 2.2 cm to -0.6 +/- 1.7 cm (P < .01). Postoperative Ba was prolapse stage II or greater in 50% of subjects. Mean incontinence impact questionnaire-7 scores improved from 36.2 +/- 31.9 to 15.6 +/- 26.2 (P < .01), as did mean urogenital distress inventory-6 scores from 58.2 +/- 26.8 to 23.8 +/- 22.6 (P < .01). Significant improvements in Pelvic Organ Prolapse Quantification measures, urinary symptoms, and the impact of incontinence were seen after the operation. However, a significant proportion of patients had Pelvic Organ Prolapse Quantification stage II prolapse or greater, which made it unclear whether graft use confers a significant advantage.

Urinary incontinence after multiple gestation and delivery: impact on quality of life

An anonymous 77-item urogenital symptom questionnaire was administered to 769 women with a history of previous multifetal gestation and delivery, including long forms of the Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI). IIQ and UDI scores were analyzed using univariate and multivariate regression to determine the impact of incontinence on quality of life (QOL). Mean age was 37 years (22-75), and nearly half [49.8% (365)] reported at least one type of incontinence. Higher mean UDI scores were reported by women with stress incontinence (SI) (12.3 vs 4.7, p=0.0001), urge incontinence (UI) (14.9 vs 5.7, p=0.0001), and mixed incontinence (15.1 vs 6.2, p=0.0001) compared to continent women. Similarly, higher mean IIQ scores were associated with SI (6.9 vs 1.9, p=0.0001), UI (9.4 vs 2.2, p=0.0001), and mixed incontinence (9.3 vs 2.7, p=0.0001). In conclusion, among "mothers of multiples," stress and urge urinary incontinence were associated with strongly adverse effects on QOL at a young age.

Paper 25: Outcomes of TVT Procedures Performed in Patients With Stress Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency or Urethral Hypermobility

OBJECTIVE: With the increasing use of Tension-Free Vaginal Tape (TVT) to treat urinary incontinence, very little evidence exists to advocate its use in patients with sphincter deficiency. Our goal is to evaluate the efficacy of TVT procedures for stress urinary incontinence in patients with intrinsic sphincter deficiency (ISD) versus those with urethral hypermobility by comparing preoperative and postoperative Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ) scores. METHODS: A chart review was done of all patients between 1999 and 2003 who had completed preoperative UDI and IIQ questionnaires and had preoperative urodynamic testing prior to undergoing a TVT procedure for stress incontinence. The difference in pre- and postoperative UDI and IIQ scores were compared between the 2 groups along with the difference in UDI subscales. ISD was defined as an Ucp ≤ 20 and urethral hypermobility as a ≥ 30° change in the urethral angle with Valsalva. Statistical calculations were performed using Stata 6.0 (Stata Corporation, TX). In the analysis, Pearson Chi Square was used for the categorical variables and a linear regression for the numerical variables. RESULTS: Of the eligible 109 patients, 90 completed the postoperative questionnaires between a 12–60 month time interval. There were 32 patients in the ISD group and 58 in the urethral hypermobility group. Demographic and medical data such as gravidity, parity, ethnicity, tobacco use, diabetes, chronic cough, prior incontinence procedure and concomitant procedures were not significant between the 2 groups. Age and hormonal status was statistically significant with the ISD group being older 64.43 versus 55.45 (OR 3.09, CI 1.25–2.75) and postmenopausal (OR 3.81, CI 1.28–11.31). The change in IIQ scores (postoperative-preoperative) means (ISD 5.09 ± 3.93, urethral hypermobility 7.38 ± 5.22) was not statistically significant between the 2 groups. Also a comparison of the mean postoperative IIQ scores was not statistically significant (ISD 2.31 ± 3.59, urethral hypermobility 2.41 ± 4.44). However, the changes in the difference of the total UDI scores and stress subscale were significant (ISD 6.06 ± 3.93, urethral hypermobility 8.52 ± 5.12, P=0.021 and ISD 3.34 ± 1.89, urethral hypermobility 4.57 ± 1.71, P=0.002) respectively with the greater change in the urethral hypermobility group. There was no difference between the changes in urge and void difficulty subscale scores. When isolating the mean postoperative UDI scores between the groups, no significance was obtained (ISD 3.75 ± 3.47, urethral hypermobility 3.64 ± 3.46). CONCLUSION: The TVT is equally effective in treating patients with stress incontinence secondary to intrinsic sphincter deficiency or urethral hypermobility based on the IIQ and UDI. Patients with urethral hypermobility appear to have a greater improvement in their symptoms as compared to the ISD group.