Transobturator tape surgery for stress urinary incontinence: an assessment of quality of life before and after surgery from the patient's perspective
Date
2015
Authors
Jacobson, Hayley
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Abstract
Background:
Stress urinary incontinence is a common problem in a woman’s life and has a negative
affect on her quality of life (QOL). The trans obturator tape (TOT) is a safe procedure used
to treat urinary incontinence. The operative change in the quality of life was determined
using the Kings Health Questionnaire (KHQ). This study assesses patient reported
outcomes of the TOT procedure as the primary measure of success.
Objectives:
The primary objectives of the study were to determine the subjective outcome of the QOL
and symptoms for women that underwent the TOT procedure using the King’s Health
Questionnaire (KHQ) in a tertiary academic centre. The secondary objectives assessed the
cure rate of the impact on QOL and the subjective symptoms, evaluated the outcome of
pre-operative urgency and determined if post-operative change in urinary incontinence
correlates with personal relationships (sexual function).
Method:
This was a prospective cohort study design whereby patients answered the KHQ pre
operatively on admission and post operatively at 6-24 months from January 2010 until
June 2013. Seventy-seven patients took part in this study. Ten of these patients were
excluded. The results were analysed separately in 3 groups.Stress urinary incontinence
SUI (n=50), Mixed urinary incontinence MUI (n=4), SUI with a sensation of urgency
(n=13). Logistic regression was used to determine the results.
Results:
Those patients who improved their QOL score by >75% for the SUI and MUI groups were
83% and 50% respectively. The positive improved change in QOL for the SUI and MUI
groups were 98% and 100% respectively.
Those patients who improved their subjective symptoms score by >75% for the SUI and
MUI groups were 69%, and 92% respectively. The positive change in improvement of the
symptoms for SUI and MUI groups were 100% and 75% respectively.
Those patients who improved their stress symptoms score by >75% for SUI and MUI
groups were 91% and 82% respectively.
The subjective disappearance of urgency post operatively was 69% for the SUI with
sensation of urgency group and 25% for the MUI group.
Conclusions
The trans obturator tape procedure conclusively improves the quality of life for women
with stress urinary incontinence.There are very few studies that use subjective outcomes as
their primary outcome measure. While most studies use the objective cure rate by using a
negative cough test and more stringently a pad weight test. It is important to compare the
study outcome results to other comparative studies using subjective outcomes rather than
objective outcomes. Women should be counseled preoperatively about realistic
expectations after surgery as this effects the operative outcome. In other studies subjective
cure has been inconsistently assessed. There is a strong need for a standardized definition
for subjective cure rate by the International Continence Society.
Description
A research report submitted to the Faculty of Health Sciences, University of
the Witwatersrand,Johannesburg, in partial fulfillment of the requirements
for the degree of
Master of Medicine in Obstetrics and Gynaecology.
MMed (O & G)
Johannesburg 2015