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Impact of surgery for stress incontinence on morbidity: a cohort study

Impact of surgery for stress incontinence on morbidity: a cohort study
Impact of surgery for stress incontinence on morbidity: a cohort study
Objectives: To describe the impact of surgery for stress incontinence on the severity of symptoms, other mental and physical symptoms, and overall health. To describe the incidence of postoperative complications.

Design: Prospective cohort study; questionnaires completed by patients before and 3, 6, and 12 months after surgery. Questionnaires completed by surgeons both before and after surgery.

Setting: 18 hospitals in the North Thames region.

Subjects: 442 women treated surgically for stress incontinence between January 1993 and June 1994. 367 women returned the 3 month questionnaire; 364 returned the 6 month questionnaire; and 359 returned the 12 month questionnaire. 49 surgeons provided perioperative information on 285 of the 442 women and postoperative information on 278.

Main outcome measures: Stress incontinence symptom severity index, other urinary symptoms, bowel function, mental health, complications, global measures.

Results: Most women (288; 87%) reported an improvement in the severity of their stress incontinence, though only 92 (28%) were cured (continent). These improvements persisted for at least 12 months. The likelihood of improvement was similar regardless of whether urodynamic pressure studies had been conducted before surgery. Following surgery, women were less likely to suffer from urinary frequency, nocturia, postvoid fullness, dysuria, and urgency. While mental health improved for 194 (71%), a quarter of women reported deterioration. Only 37 (10%) were satisfied with postoperative pain control. A third experienced one or more complications while in hospital, most commonly difficulty urinating. This problem affected 1 in 11 women after discharge. A year after surgery two thirds of women reported feeling better (251; 72%), that the outcome met or exceeded their expectations (230; 66%), and that they would recommend the operation to a friend in a similar situation (239; 68%). Surgeons tended to be more optimistic about the effects of surgery; they were satisfied with the outcome in 176 (85%) cases and would again treat 245 (94%) of the women as they had done previously.

Conclusions: Although surgery reduces the severity of stress incontinence it is not as effective as current textbooks suggest. Women considering surgery should be provided with more accurate information on the likelihood of an improvement in symptoms and the occurrence of complications, including postoperative pain. Urgency and urge incontinence should not be considered contraindications to surgery. The need for urodynamic assessment before surgery should be reappraised.
cohort, incontinence, morbidity, stress, Stress incontinence, surgery
0959-8138
1493 - 1498
Black, Nick
c8c5da0a-ea06-4a93-bedf-82f980016bb9
Griffiths, Joanne
e646efe7-c7e3-4aba-958f-c534b0bd5fb2
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Abel, Paul
84c36938-1d65-4f06-bc17-137a9a8f5886
Black, Nick
c8c5da0a-ea06-4a93-bedf-82f980016bb9
Griffiths, Joanne
e646efe7-c7e3-4aba-958f-c534b0bd5fb2
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Abel, Paul
84c36938-1d65-4f06-bc17-137a9a8f5886

Black, Nick, Griffiths, Joanne, Pope, Catherine, Bowling, Ann and Abel, Paul (1997) Impact of surgery for stress incontinence on morbidity: a cohort study. British Medical Journal, 315 (7121), 1493 - 1498. (doi:10.1136/bmj.315.7121.1493). (PMID:9420489)

Record type: Article

Abstract

Objectives: To describe the impact of surgery for stress incontinence on the severity of symptoms, other mental and physical symptoms, and overall health. To describe the incidence of postoperative complications.

Design: Prospective cohort study; questionnaires completed by patients before and 3, 6, and 12 months after surgery. Questionnaires completed by surgeons both before and after surgery.

Setting: 18 hospitals in the North Thames region.

Subjects: 442 women treated surgically for stress incontinence between January 1993 and June 1994. 367 women returned the 3 month questionnaire; 364 returned the 6 month questionnaire; and 359 returned the 12 month questionnaire. 49 surgeons provided perioperative information on 285 of the 442 women and postoperative information on 278.

Main outcome measures: Stress incontinence symptom severity index, other urinary symptoms, bowel function, mental health, complications, global measures.

Results: Most women (288; 87%) reported an improvement in the severity of their stress incontinence, though only 92 (28%) were cured (continent). These improvements persisted for at least 12 months. The likelihood of improvement was similar regardless of whether urodynamic pressure studies had been conducted before surgery. Following surgery, women were less likely to suffer from urinary frequency, nocturia, postvoid fullness, dysuria, and urgency. While mental health improved for 194 (71%), a quarter of women reported deterioration. Only 37 (10%) were satisfied with postoperative pain control. A third experienced one or more complications while in hospital, most commonly difficulty urinating. This problem affected 1 in 11 women after discharge. A year after surgery two thirds of women reported feeling better (251; 72%), that the outcome met or exceeded their expectations (230; 66%), and that they would recommend the operation to a friend in a similar situation (239; 68%). Surgeons tended to be more optimistic about the effects of surgery; they were satisfied with the outcome in 176 (85%) cases and would again treat 245 (94%) of the women as they had done previously.

Conclusions: Although surgery reduces the severity of stress incontinence it is not as effective as current textbooks suggest. Women considering surgery should be provided with more accurate information on the likelihood of an improvement in symptoms and the occurrence of complications, including postoperative pain. Urgency and urge incontinence should not be considered contraindications to surgery. The need for urodynamic assessment before surgery should be reappraised.

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More information

Published date: 6 December 1997
Keywords: cohort, incontinence, morbidity, stress, Stress incontinence, surgery
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 334774
URI: http://eprints.soton.ac.uk/id/eprint/334774
ISSN: 0959-8138
PURE UUID: 2f48e926-18a0-4f2d-8ef4-c77cd8034096
ORCID for Catherine Pope: ORCID iD orcid.org/0000-0002-8935-6702

Catalogue record

Date deposited: 22 Mar 2012 11:09
Last modified: 14 Mar 2024 10:36

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Contributors

Author: Nick Black
Author: Joanne Griffiths
Author: Catherine Pope ORCID iD
Author: Ann Bowling
Author: Paul Abel

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