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Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence

International Urogynecology Journal volume 26, pages 329–334 (2015)Cite this article

Abstract

Introduction and hypothesis

To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women.

Methods

This was a cohort study including women with moderate to severe stress incontinence who were allocated to the physiotherapy arm from a previously reported multicentre trial comparing initial surgery or initial physiotherapy in treating stress urinary incontinence. Crossover to surgery was allowed.

Results

Data from 198/230 women who were randomized to physiotherapy was available for analysis, of whom 97/198 (49 %) crossed over to surgery. Prognostic factors for undergoing surgery after physiotherapy were age <55 years at baseline (OR 2.87; 95 % CI 1.30–6.32), higher educational level (OR 3.28; 95 % CI 0.80–13.47), severe incontinence at baseline according to the Sandvik index (OR 1.77; 95 % CI 0.95–3.29) and Urogenital Distress Inventory; incontinence domain score (OR 1.03; per point; 95 % CI 1.01–1.65). Furthermore, there was interaction between age <55 years and higher educational level (OR 0.09; 95 % CI 0.02–0.46). Using these variables we constructed a prediction rule to estimate the risk of surgery after initial physiotherapy.

Conclusion

In women with moderate to severe stress incontinence, individual prediction for surgery after initial physiotherapy is possible, thus enabling shared decision making for the choice between initial conservative or invasive management of stress urinary incontinence.

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Acknowledgments

On behalf of the PORTRET study group: listed at the end of the main body of the text.

Funded with a grant by Zon MW, the Netherlands Organization for Health Research and Development. Trial Registration: Dutch Trial Register number, NTR1248

We would like to acknowledge all participating gynecologists in the PORTRET study group in collaboration with the Dutch urogynecological consortium:

A.L. Milani MD, PhD, Reinier de Graaf Gasthuis

I. v/d Wijk MD, Groene Hart Hospital

D.J.C. Smalbraak MD, Amphia Hospital

R.A. Hakvoort MD, PhD and A. Vollebreg, MD, PhD, Spaarne Hospital

M.H. Kerkhof MD and R.P. Schellart, Kennemer Gasthuis

G.C.M. Graziosi MD, PhD, Sint Antonius Hospital

J.M. v/d Ploeg MD, Martini Hospital

J.F.G.M. Brouns MD, PhD, Zaans Medical Centre,

E.S.M. Tiersma, Vrije Universiteit Medical Centre

A.G. Groenendijk MD, PhD, Onze Lieve Vrouwen Gasthuis

P.C. Scholten MD, PhD, Diakonessenhuis

B.W. Mol MD, PhD, Academic Medical Centre Amsterdam

E.E. Blokhuis MD, Zuwe Hofpoort Hospital

A.H. Adriaanse MD, PhD, Medical Centre Alkmaar

A. Schram MD, PhD, University Medical Centre Groningen

J.P.W.R. Roovers MD, PhD, Academic Medical Centre Amsterdam

Conflict of interest

None

Author information

Affiliations

  1. University Medical Centre Utrecht, Room: F05.121, Heidelberglaan 100, PO Box 85500, 3508, GA, Utrecht, The Netherlands

    J. Labrie, K. Fischer & C. H. van der Vaart

  2. University Medical Centre Nijgemen, PO Box 9101, 6500, HB, Nijmegen, The Netherlands

    A. L. M. Lagro-Janssen

  3. University Medical Centre Maastricht, PO Box 5800, 6202, AZ, Maastricht, The Netherlands

    L. C. M. Berghmans

Authors
  1. J. Labrie
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  2. A. L. M. Lagro-Janssen
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  3. K. Fischer
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  4. L. C. M. Berghmans
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  5. C. H. van der Vaart
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Corresponding author

Correspondence to J. Labrie.

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Labrie, J., Lagro-Janssen, A.L.M., Fischer, K. et al. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence. Int Urogynecol J 26, 329–334 (2015). https://doi.org/10.1007/s00192-014-2473-z

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  • DOI: https://doi.org/10.1007/s00192-014-2473-z

Keywords

  • Stress urinary incontinence
  • Midurethral sling surgery
  • Pelvic floor muscle training
  • Predicting