Association of baseline severity of lower urinary tract symptoms with the success conservative therapy for urinary incontinence in women
- 20 Downloads
Introduction and hypothesis
To identify the association between the symptom severity and outcome of conservative management for OAB, SUI and MUI. Conservative treatments are recommended for overactive bladder (OAB), stress urinary incontinence (SUI) and mixed incontinence (MUI). It is unclear whether disease severity affects treatment outcome.
Patients receiving conservative management were reviewed. Disease-specific questionnaires (OAB-q SF, ICIQ-UI SF) and bladder diaries recorded baseline symptoms. Success was defined by Patient Global Impression of Improvement questionnaire (PGI-I) response of “very much better” or “much better”. Non-parametric statistical tests and logistic regression were used.
In 50 OAB patients success was associated with lower symptom severity [30 (0–80) vs. 80 (23–100), p = 0.0001], fewer urgency episodes [4 (0–12) vs. 6 (0–11), p = 0.032] and lower ICIQ-UI SF [5.5 (0–20) vs. 15 (0–21), p = 0.002], but higher QoL [67 (20–101) vs. 24 (6–58), p = 0.0001]. In 50 MUI patients, variables were fewer urgency episodes [3 (0–10) vs. 6 (0–16), p = 0.004] and lower ICIQ-UI [11 (1–18) vs. 15 (5–21), p = 0.03]. In 40 SUI patients, variables were fewer incontinence episodes [1 (0–4) vs. 2 (0–5), p = 0.05] and lower ICIQ-UI [11 (6–16) vs. 13.5 (11–19), p = 0.003]. Multiple regression confirmed OAB-q QoL [odds ratio (OR) 1.10 (95% confidence intervals 1.04, 1.1)] for OAB, urgency episodes [OR 0.74 (0.56, 0.98)] and ICIQ-UI [OR 0.83 (0.71, 0.98] for MUI and ICIQ-UI [OR 0.57 (0.40, 0.83)] for SUI.
Milder baseline disease severity was associated with successful outcome. There is potential for triage at initial assessment to second-line interventions for women unlikely to achieve success.
KeywordsConservative therapy OAB Symptom severity Urinary incontinence
Compliance with ethical standards
This work took place at the Leicester General Hospital NHS Trust, UK.
No ethical approval was required for this work.
Conflicts of interest
- 4.Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20.Google Scholar
- 5.Practice Bulletin no. 155: Urinary incontinence in women. Obstetrics and Gynecology. 2015;126(5):e66–e81.Google Scholar
- 13.Ostaszkiewicz J, Chestney T, Roe B. Habit retraining for the management of urinary incontinence in adults. Cochrane Database Syst Rev. 2004;(2):CD002801.Google Scholar
- 14.Wallace SA, Roe B, Williams K, Palmer M. Bladder training for urinary incontinence in adults. Cochrane Database Syst Rev. 2004;(1):CD001308.Google Scholar
- 15.Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;(5):CD005654.Google Scholar
- 18.Laycock J. Clinical evaluation of the pelvic floor. In: Schussler B, Laycock J, Norton P, Stanton SL, editors. Pelvic floor re-education. London: Springer-Verlag; 1994. p. 42–8.Google Scholar
- 22.Chapple C, Khullar V, Nitti VW, Frankel J, Herschorn S, Kaper M, et al. Efficacy of the beta3-adrenoreceptor agonist mirabegron for the treatment of overactive bladder by severity of incontinence at baseline: a post-hoc analysis of pooled data from three randomised phase 3 trials. Eur Urol. 2015;67:11–4.CrossRefPubMedGoogle Scholar
- 33.Dumoulin C, Desmeule F, Hagen S, Masse BR, Mayrand M-H, Morin M, et al. Development and validation of a clinical prediction rule to guide and improve the treatment of female stress urinary incontinence. http://webapps.cihr-irsc.gc.ca/decisions/p/project_details.html?applId=344799&lang=en. Accessed 13 Apr 2018.