International Urogynecology Journal

, Volume 24, Issue 1, pp 15–25 | Cite as

Measuring outcomes in urogynecological surgery: “perspective is everything”

  • Candace Y. Parker-Autry
  • Matthew D. Barber
  • Kimberly Kenton
  • Holly E. Richter
Review Article

Abstract

Over 10 years have passed since the first US National Institutes of Health consensus panel considered the standardization of definitions of pelvic floor conditions and the criteria utilized for reporting pelvic floor research study outcomes. The literature is replete with pelvic floor outcome studies; however, a consistent standardized approach to the evaluation of patients and characterization of outcomes is still needed. The purpose of this overview is to describe how the use of outcome measures has evolved over time and to attempt to help readers utilize the best measures for their clinical and research needs.

Keywords

Pelvic floor disorder research Urogynecologic surgical outcomes 

Abbreviations

PFDs

Pelvic floor disorders

UI

Urinary incontinence

SUI

Stress urinary incontinence

Notes

Conflicts of interest

None.

References

  1. 1.
    Hilton P, Robinson D (2011) Defining cure. Neurourol Urodyn 30(5):741–745CrossRefPubMedGoogle Scholar
  2. 2.
    Cooke JN, Gousse AE (2008) A historical perspective on cystocele repair—from honey to pessaries to anterior colporrhaphy: lessons from the past. J Urol 179:2126–2130CrossRefPubMedGoogle Scholar
  3. 3.
    Deger RB, Menzin AW, Mikuta JJ (1993) The vaginal pessary: past and present. Postgrad Obstet Gynecol 13(18):1–8Google Scholar
  4. 4.
    Kelly HA, Dumm WM (1998) Urinary incontinence in women, without manifest injury to the bladder. 1914. Int Urogynecol J Pelvic Floor Dysfunct 9(3):158–164CrossRefPubMedGoogle Scholar
  5. 5.
    White GR (1909) A radical cure by suturing lateral sulci of vagina to white line of pelvic fascia. JAMA 53:1707CrossRefGoogle Scholar
  6. 6.
    White GR (1912) An anatomical operation for the cure of cystocele. Am J Obstet Dis Women Child 65:286Google Scholar
  7. 7.
    Richardson AC, Lyon JB, Williams NL (1976) A new look at pelvic relaxation. Am J Obstet Gynecol 126(5):568–573PubMedGoogle Scholar
  8. 8.
    Jarvis GJ (1994) Surgery for genuine stress incontinence. Br J Obstet Gynaecol 101(5):371–374CrossRefPubMedGoogle Scholar
  9. 9.
    Fantl JA, Colling ND et al (1996) Urinary incontinence in adults: acute and chronic management. Clinical Practice Guideline No. 2.AHCPR Publication No. 96-0682. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Clinical Practice Guideline No. 2.AHCPR Publication No. 96-0682. Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human ServicesGoogle Scholar
  10. 10.
    Black NA, Downs SH (1996) The effectiveness of surgery for stress incontinence in women: a systematic review. Br J Urol 78(4):497–510CrossRefPubMedGoogle Scholar
  11. 11.
    Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski RR et al (2001) The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct 12(3):178–186CrossRefPubMedGoogle Scholar
  12. 12.
    Bonney V (1923) On diurnal incontinence of urine in women. J Obstet Gynaecol Brit Emp 30:358–365CrossRefGoogle Scholar
  13. 13.
    Swift SE, Yoon EA (1999) Test-retest reliability of the cough stress test in the evaluation of urinary incontinence. Obstet Gynecol 94(1):99–102CrossRefPubMedGoogle Scholar
  14. 14.
    Scotti RJ, Myers DL (1993) A comparison of the cough stress test and single-channel cystometry with multichannel urodynamic evaluation in genuine stress incontinence. Obstet Gynecol 81(3):430–433PubMedGoogle Scholar
  15. 15.
    Nager CW, Brubaker L, Litman HJ, Aycsynski HM, Varner RE, Amundsen C et al (2012) A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 366(21):1987–1997CrossRefPubMedGoogle Scholar
  16. 16.
    Crystle CD, Charme LS, Copeland WE (1971) Q-tip test in stress urinary incontinence. Obstet Gynecol 38(2):313–315PubMedGoogle Scholar
  17. 17.
    Swift SE, Barnes D, Herron A, Goodnight W (2010) Test-retest reliability of the cotton swab (Q-tip) test in the evaluation of the incontinent female. Int Urogynecol J 21(8):963–967CrossRefPubMedGoogle Scholar
  18. 18.
    Robinson BL, Geller EJ, Parnel BA, Crane AK, Jannelli ML, Wells EC et al (2012) Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial. Am J Obstet Gynecol 206(6):528.e1–528.e6CrossRefGoogle Scholar
  19. 19.
    Ryhammer AM, Djurhuus JC, Laurberg S (1999) Pad testing in incontinent women: a review. Int Urogynecol J Pelvic Floor Dysfunct 10(2):111–115CrossRefPubMedGoogle Scholar
  20. 20.
    Abrams PH, Skidmore R, Poole AC, Follet D (1998) The standardisation of terminology of lower urinary tract function. The international continence society committee on standardisation of terminology. Scand J Urol Nephrol Suppl 114:5–19Google Scholar
  21. 21.
    Derpapas A, Digesu GA, Fernando R, Khullar V (2011) Imaging in urogynaecology. Int Urogynecol J 22(11):1345–1356CrossRefPubMedGoogle Scholar
  22. 22.
    Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE et al (1996) Interobserver and intraobserver reliability of the proposed international continence society, society of gynecologic surgeons, and American urogynecologic society pelvic organ prolapse classification system. Am J Obstet Gynecol 175(6):1467–1470, discussion 1470–1471CrossRefPubMedGoogle Scholar
  23. 23.
    Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P et al (2008) The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the colpopexy and urinary reduction efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct 19(5):607–614CrossRefPubMedGoogle Scholar
  24. 24.
    Wei J, Nygaard I, Richter H, Brown M, Barber M, Xiao X et al (2009) Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial–design and methods. Clin Trials 6(2):162–171CrossRefPubMedGoogle Scholar
  25. 25.
    Richter HE, Burgio KL, Goode PS, Borello-France D, Bradley CS, Brubaker L et al (2007) Non-surgical management of stress urinary incontinence: ambulatory treatments for leakage associated with stress (ATLAS) trial. Clin Trials 4(1):92–101CrossRefPubMedGoogle Scholar
  26. 26.
    Brubaker L, Barber MD, Nygaard I, Nager CW, Varner E, Schaffer J et al (2010) Quantification of vaginal support: are continuous summary scores better than POPQ stage? Am J Obstet Gynecol 203(5):512.e1–512.e6CrossRefGoogle Scholar
  27. 27.
    Abrams PH, Blaivas JG, Stanton SL, Anderson JT (1983) The concept and measurement of bladder work. A review after 6 years. Br J Urol 55(2):199CrossRefPubMedGoogle Scholar
  28. 28.
    Dmochowski RR, Sanders SW, Appell RA, Nitti VW, Davila GW (2005) Bladder-health diaries: an assessment of 3-day vs 7-day entries. BJU Int 96(7):1049–1054CrossRefPubMedGoogle Scholar
  29. 29.
    Staskin D, Kelleher C, Avery K, Bosch R, Cotterill N, Coyne K et al (2009) Committee 5 B: patient-reported outcome assessment. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence, 4th edn. Health Publication, Paris, pp 363–412Google Scholar
  30. 30.
    Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantle JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Continence program for women research group. Neurourol Urodyn 14(2):131–139CrossRefPubMedGoogle Scholar
  31. 31.
    The World Health Organization Quality of Life Assessment (WHOQOL) (1998) Development and general psychometric properties. Soc Sci Med 46(12):1569–1585CrossRefGoogle Scholar
  32. 32.
    Centers for Disease Control (2000) Measuring healthy days: Population assessment of health-related quality of lifeGoogle Scholar
  33. 33.
    Daker-White G (2002) Reliable and valid self-report outcome measures in sexual (dys)function: a systematic review. Arch Sex Behav 31(2):197–209CrossRefPubMedGoogle Scholar
  34. 34.
    Rogers RG, Kammerer-Doak D, Villarreal A, Coates KW, Qualls C (2001) A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol 184(4):552–558CrossRefPubMedGoogle Scholar
  35. 35.
    Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14(3):164–168, discussion 168CrossRefPubMedGoogle Scholar
  36. 36.
    Parnell BA, Dunivan GC, Connolly A, Jannelli ML, Wells C, Geller EJ (2011) Validation of web-based administration of the pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12). Int Urogynecol J 22(3):357–361CrossRefPubMedGoogle Scholar
  37. 37.
    Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189(1):98–101CrossRefPubMedGoogle Scholar
  38. 38.
    Geller EJ, Barbee ER, Wu JM, Loomis MJ, Visco AG (2007) Validation of telephone administration of 2 condition-specific quality-of-life questionnaires. Am J Obstet Gynecol 197(6):632.e1–632.e4CrossRefGoogle Scholar
  39. 39.
    Brown JS, Posner SF, Stewart AL (1999) Urge incontinence: new health-related quality of life measures. J Am Geriatr Soc 47(8):980–988PubMedGoogle Scholar
  40. 40.
    Patrick DL, Martin ML, Bushnell DM, Yalcin I, Wagner TH, Buesching DP (1999) Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL). Urology 53(1):71–76CrossRefPubMedGoogle Scholar
  41. 41.
    Barber MD, Walters MD (2005) Bump RC (2005) short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113CrossRefPubMedGoogle Scholar
  42. 42.
    Handa VL, Barber MD, Young SB, Aronson MP, Morse A, Cundiff GW (2008) Paper versus web-based administration of the pelvic floor distress inventory 20 and pelvic floor impact questionnaire 7. Int Urogynecol J Pelvic Floor Dysfunct 19(10):1331–1335CrossRefPubMedGoogle Scholar
  43. 43.
    Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls L et al (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362(22):2066–2076CrossRefPubMedGoogle Scholar
  44. 44.
    Swift SE, Woodman P, O’Boyle A, Khan M, Valley M, Bland D et al (2005) Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192(3):795–806CrossRefPubMedGoogle Scholar
  45. 45.
    Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185(6):1299–1304, discussion 1304–1306CrossRefPubMedGoogle Scholar
  46. 46.
    Barber MD, Brubaker L, Nygaard I, Wheeler TL, Schaffer J, Chen Z et al (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609CrossRefPubMedGoogle Scholar
  47. 47.
    Chmielewski L, Walters MD, Weber AM, Barber MD (2011) Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol 205(1):69.e1–69.e8CrossRefGoogle Scholar
  48. 48.
    Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H (1993) Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health 47(6):497–499CrossRefPubMedGoogle Scholar
  49. 49.
    Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330CrossRefPubMedGoogle Scholar
  50. 50.
    Brookes ST, Donovan JL, Wright M, Jackson S, Abrams P (2004) A scored form of the Bristol female lower urinary tract symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am J Obstet Gynecol 191(1):73–82CrossRefPubMedGoogle Scholar
  51. 51.
    Bradley CS, Rahn DD, Nygaard IE, Barber MD, Nager CW, Kenton K et al (2010) The questionnaire for urinary incontinence diagnosis (QUID): validity and responsiveness to change in women undergoing non-surgical therapies for treatment of stress predominant urinary incontinence. Neurourol Urodyn 29(5):727–734CrossRefPubMedGoogle Scholar
  52. 52.
    Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42(12):1525–1532CrossRefPubMedGoogle Scholar
  53. 53.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97CrossRefPubMedGoogle Scholar
  54. 54.
    Price N, Jackson SR, Avery K, Brookers ST, Abrams P (2006) Development and psychometric evaluation of the ICIQ vaginal symptoms questionnaire: the ICIQ-VS. BJOG 113(6):700–712CrossRefPubMedGoogle Scholar
  55. 55.
    Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104(12):1374–1379CrossRefPubMedGoogle Scholar
  56. 56.
    Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AF et al (2000) Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43(1):9–16, discussion 16–17CrossRefPubMedGoogle Scholar
  57. 57.
    Kwon S, Visco AG, Fitzgerald MP, Ye W, Whitehead WE, Pelvic Floor Disorders Network (2005) Validity and reliability of the modified Manchester health questionnaire in assessing patients with fecal incontinence. Dis Colon Rectum 48(2):323–331, discussion 331–334CrossRefPubMedGoogle Scholar
  58. 58.
    Digesu GA, Khullar V, Cardozo L, Robinson D, Salvatore S (2005) P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 16(3):176–181, discussion 181CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Candace Y. Parker-Autry
    • 1
  • Matthew D. Barber
    • 2
  • Kimberly Kenton
    • 3
  • Holly E. Richter
    • 1
  1. 1.Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Center for Urogynecology and Pelvic Reconstructive SurgeryObstetrics and Gynecology and Women’s Health Institute, Cleveland ClinicClevelandUSA
  3. 3.Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology & UrologyLoyola UniversityMaywoodUSA

Personalised recommendations