Treatment of female stress urinary incontinence: what women find acceptable and the impact of clinical and urodynamic evaluation on their final choice

Abstract

Objectives. The aim of this study was determine what women find acceptable regarding treatment modality for Stress urinary incontinence (SUI) and to assess the impact of clinical and urodynamic evaluation on their final decision. Material and methods. This prospective, institutional review board-approved study included 100 consecutive women with primary SUI. All women were given a questionnaire that included the Urinary Distress Inventory (UDI-6) and the American Urologic Association Quality of Life questionnaire (AUA-QoL6). The patients were also asked to choose one of the four available treatment options, which included major surgeries, minor surgeries, office procedures and medication. Factors affecting the initial choice of treatment were studied. A Q-tip test and multichannel urodynamics were then carried out and the patients were recounseled by the urologist. The patients' final decision was compared with their initial choice and statistical analysis was performed. Results. Initially, 22% patients chose major surgery, 39% minor surgery, 27% an office procedure and 12% medication. This was affected by age, symptom severity and quality of life bother. After clinical and urodynamic evaluation, 34% shifted to a different treatment modality; this correlated significantly with young age, severe symptoms, limited urethral mobility and low Valsalva leak point pressure. Conclusions. Patients' initial choice for treatment of SUI was affected by age, symptom severity and quality of life; however, the final decision was more influenced by the clinical and urodynamic evaluation. It is important to counsel the patients before definitive treatment, to achieve a better outcome.

Key Words::

• evaluation
• patient's choice
• stress urinary incontinence
• treatment

Declaration of interest: M. Elmissiry and A. Mahdy have no conflicts of interest to declare. G. Ghoniem is a consultant on uroplasty, a consultant and advisory board member on coloplasty, a consultant to Boston Scientific(cadaver lab), and an advisory board and speaker for Astellas.