Urinary symptoms are very common in adults over 40 years of age living in the community. However, symptom-based estimates probably overestimate the level of need for health care in the community. It may be more effective and efficient to target services, in the first instance, on those people who report clinically significant symptoms that are bothersome or socially disabling. A consensus on thresholds and definitions of urinary symptoms is required to standardize clinical and research work and to target services more appropriately.

This qualitative study was undertaken to assess patients' views of the urodynamic investigation. The aim was to identify the dimensions important to patients in evaluating satisfaction with this type of procedure and ways in which care could be improved. Unstructured interviews were carried out by four trained interviewers with 21 people (17 female and 4 male) who had undergone the urodynamic investigation at various gynaecology, urology and continence outpatient clinics. The interviews were audio-taped and transcribed verbatim. The data was then coded and a thematic analysis carried out. The main theme to emerge was focused on patients' feelings about the procedure. This consisted of a combination of anxiety and embarrassment. Anxiety was because of fear of the unknown and embarrassment at the intimate nature of the procedure and lack of privacy. The interpersonal and communication skills of the health care professional were central in alleviating these negative feelings. The establishment of a friendly relationship based on equality and mutual respect and trust was important in preventing anxiety and embarrassment. A number of practical issues were identified that would contribute to improving the service for patients. It was found that nurses possessed all the attributes required to provide an effective service and recommendations were made that nurses specializing in continence care should take a more active role in urodynamic investigations.

Contributing to national databases gives useful information that may be difficult to ascertain from RCTs. Suburethral tapes appear to have good efficacy and low complications with increasing age.

Records were identified through outpatient clinic lists, surgery lists, nursing and physiotherapy lists. Data were collated and analysed for trends RESULTSIn all, 412 women (mean age 54.6 years, SD 12.6) covering 1406 visits to secondary care were covered by the study. Most women had a symptomatic diagnosis of mixed UI and mild to moderate UI, as defined by their physician. Most women had conservative therapies by either continence nurses or physiotherapists, regardless of the severity of their condition; 73% had cystometry and 39% were recommended for surgical intervention. CONCLUSIONSWomen largely undergo similar procedures in secondary care. Most present with mixed UI. The perceived severity of disease did not preclude a trial of conservative therapies. KEYWORDS incontinence, secondary care, treatment patterns OBJECTIVESTo describe the treatment trends for women with urinary incontinence (UI) after their referral from primary to secondary care, as despite the high prevalence of UI within the female population, relatively few women actively seek treatment for their UI and fewer reach secondary care. PATIENTS AND METHODSWe retrospectively reviewed the notes of patients attending in two randomly selected months in five hospital sites in the UK.

estimate the relative risk of symptoms between groups. Data from 7810 men were included in the analysis. RESULTSIn all, 409 (5.3%) of the population sample described themselves as Asian; 36.5% of these men described at least one significant LUTS, vs 29.0% of white men. The overall prevalence rates for all storage symptoms were significantly higher in Asian men. Straining to void was the only voiding symptom to show a difference in prevalence between the groups. However, when controlling for age, Asian men were at greater risk for all symptoms except a weak urinary stream. Reported levels of bother and felt need were the same in both population groups, but actual help-seeking was significantly less in the Asian group. Only 25.0% of Asian men had actively sought help, compared to 53.1% of white men. CONCLUSIONSouth Asian men in the UK have a higher risk of experiencing LUTS than white men from the same population. This increase in risk is greatest for storage symptoms. Although levels of bother are the same, South Asian men are less likely to seek help for their symptoms.

The British Society of Urogynaecology allows members to enter and access pre-, intra-and postoperative data relating to any antiincontinence and/or prolapse procedure onto the database. Treatment of patient identifiable data within the database fulfils the Caldicott Guardian principles. The database allows users to create reports based on their own outcomes and complications following surgery. The database is a useful tool for audit, clinical governance, personal development and appraisal. Learning objectivesTo understand how to access the database. To understand the benefits of the database. To appreciate that the benefits of the database depends on the quality of data entered.

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