Impact of surgery for stress incontinence on the social lives of women

Objective: To assess the feasibility of collecting disease-specific and generic data on the impact of surgery on the social lives of women with stress incontinence; to describe the social impact of surgery in a representative group; and to determine the effect of timing on the assessment of outcome.Design Longitudinal study: questionnaires before and three, six, and twelve months after surgery.Setting: Eighteen hospitals in North Thames region.Participants: Four hundred and forty-two women undergoing surgery for stress incontinence between January 1993 and June 1994.Main outcome measures: Post-operative recovery time, stress incontinence symptom impact index, activities of daily living, and cost of protection.Results: Post-operative recovery was uneventful for most women, but three months after surgery 24% of those in paid employment beforehand were still on sick or unpaid leave. Most women (75%) reported that stress incontinence had less adverse impact on their lives three months after surgery, though 18% reported no change, and 7% felt life was worse. The likelihood of improvement was similar regardless of whether pre-operative urodynamic studies had been conducted. The extent of improvement was dependent on pre-operative severity. Similar findings were obtained six and twelve months after surgery. After an initial slight but nonsignificant deterioration in their ability to carry out activities of daily living, women gained a slight benefit from surgery (proportion with no or only slight limitation rose from 72% to 82%; P= 0.0001). The mean cost of protection (pads and towels) fell from £8.59 a month before surgery to £2.99 a month one year after surgery, by which time 68% of women were not using protection. In contrast, 11% were still spending over £10 a month.Conclusions: It is possible to collect standard data on the impact of surgery on social functioning and, thus, provide women with better information on likely outcomes. The benefits of pre-operative urodynamic investigations need to be assessed. The stability of the outcome measures over the first post-operative year suggest that outcomes need to be assessed only once and at any time from three to twelve months after the operation

Sociodemographic and symptomatic characteristics of women undergoing stress incontinence surgery in the UK

Objectives To: (ii describe the sociodemographic characteristics of women undergoing surgery for stress incontinence in the UK and the ways in which they differ from women of a similar age in the general population; (ii) the severity and impact of their symptoms and their expectations of surgery and; (iii) their general state of health.Patients and methods A prospective cohort study was carried out on 442 women undergoing surgery for stress incontinence in 18 hospitals in the North Thames region between January 1993 and Tune 1994. Sociodemographic factors, stress incontinence severity, symptom impact scores, and general health status were measured.Results Women undergoing surgery for stress incontinence were similar to their peers in the general population apart from being more likely to have smoked (61.4 against 51.1%), to have subsequently given up (39.5 and 25.3%) and to be of higher parity (greater than or equal to 4; 19.7 and 12.0%). Most women (81.6%) reported moderate to very severe stress incontinence, The impact of symptoms was correlated positively with severity (P<0.001) after accounting for its positive correlation with mental health status (P<0.005), socioeconomic status (P<0.05) and its negative correlation with age (P<0.02). Many women also suffered from other urinary symptoms including urgency (76%) and frequency (42.3%). Apart from their urinary problems, women were in good health (77% reported no or only mild coexistent conditions), However, a very high proportion (34.2%) had previously undergone a hysterectomy.Conclusions These results suggest that women undergoing stress incontinence surgery are remarkably similar to their peers, apart from their primary condition. The effect that stress incontinence has on women's lives depends not only on the severity of the problem but also on other factors. The high rate of previous hysterectomy warrants further study