Improvement in a Improvement in a Woman’s Woman’s

Quality of Life After a Quality of Life After a Surgical Surgical

Stress Urinary Stress Urinary ProcedureProcedure

Chambers S, English S, McGarr Chambers S, English S, McGarr R.R.

Urology DeptUrology Dept

Christchurch HospitalChristchurch Hospital

AimAim

To determine if quality of life To determine if quality of life (QOL) is improved by an operation (QOL) is improved by an operation for stress urinary incontinencefor stress urinary incontinence

Can we predict before surgery Can we predict before surgery which women will do well and which women will do well and which may not?which may not?

MethodMethod

Prospective audit Prospective audit

Preadmission clinic Preadmission clinic

QOL Questionnaire (I-QOL)QOL Questionnaire (I-QOL)

6 months following surgery6 months following surgery

QOL QuestionnaireQOL Questionnaire““My incontinence is always on my mind.”My incontinence is always on my mind.”

““I worry about coughing or sneezing I worry about coughing or sneezing because of my urinary problems or because of my urinary problems or incontinence.”incontinence.”

5 options to consider5 options to consider 1 extremely1 extremely 2 quite a bit 2 quite a bit 3 moderately3 moderately 4 a little bit4 a little bit 5 not at all5 not at all

Results to Sept 1Results to Sept 1stst, 2008, 2008

64 patients64 patients

35 patients completed pre and post I-QOL35 patients completed pre and post I-QOL

I-QOL scores increased from a mean of 41 I-QOL scores increased from a mean of 41 to a mean of 75 (p<0.0001)to a mean of 75 (p<0.0001)

ResultsResultsPre-op score

MeanPost-op scoreMean

Lowest 1/3(n = 14) 14 66

Middle 1/3(n = 14) 49 81

Highest 1/3(n = 7) 78 84

Whole group(n = 35) 41 75

Subscale ResultsSubscale ResultsSub groups(p<0.0001)

Pre-op scoreMean

Post-op scoreMean

Embarrassment

(n = 35)

31 72

Avoidance&

limiting behaviour(n = 35)

41 74

Psychosocial(n = 35)

43 79

Worsened QOL Scores

0

10

20

30

40

50

60

70

80

1 2

Pt 1

Pt 2

Pt 3

Pt 4

Pt 5

Pt 6

Pre op

Post op

ConclusionConclusion

The audit confirms that QOL is The audit confirms that QOL is improved following a surgical repair improved following a surgical repair for stress urinary incontinencefor stress urinary incontinence

Those women with a poor pre Those women with a poor pre operative QOL score are more likely operative QOL score are more likely to experience the most significant to experience the most significant improvementimprovement

ReferencesReferences

Fultz NH, Burgio K, Diokno AC, Kinchen KS, Fultz NH, Burgio K, Diokno AC, Kinchen KS, Obenchain R, Bump RC. Burden of stress Obenchain R, Bump RC. Burden of stress urinary incontinence for community urinary incontinence for community dwelling- women. AM J Obstet Gynecol. dwelling- women. AM J Obstet Gynecol. 2003;189:1275-1282.2003;189:1275-1282.

Donovan J, Naughton M, Gotoh M, et al. Donovan J, Naughton M, Gotoh M, et al. Symptom and Quality of Life Assessment Symptom and Quality of Life Assessment 1999, pp 297-309 in “Incontinence” Ed. 1999, pp 297-309 in “Incontinence” Ed. Abrams P, Khoury S, and Wein A. 1Abrams P, Khoury S, and Wein A. 1stst International Consultation on Incontinence International Consultation on Incontinence 1998.1998.