Long-term Efficacy and Safety of Questionnaire-Based Initiation of Urgency Urinary Incontinence Treatment

Abstract

Requests for reprints Corresponding author (for editorial use only): Rachel Hess, MD, MS, Center for Research on Health Care, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, 412-692-2025 (phone), 412-725-5276 (cell), 412-692-4838 (fax) Objectives-To determine the longer-term efficacy and safety of initiating treatment for urgency-predominant urinary incontinence (UUI) in women diagnosed using a simple questionnaire rather than an extensive evaluation.Study Design-Women completing a 12-week randomized controlled trial of fesoterodine therapy for UUI diagnosed by questionnaire were invited to participate in a 9-month open label continuation study. UUI and voiding episodes were collected using voiding diaries. Participant satisfaction was measured by questionnaire. Safety was assessed by measurement of post void residual volume and adverse event monitoring; if necessary, women underwent specialist evaluation. Longitudinal changes in UUI and voiding episodes were evaluated using linear mixed models adjusting for baseline.Results-Of the 567 women completing the randomized trial, 498 (87.8%) took at least one dose of medication during this open label study. Compared to the enrollment visit in the randomized trial, fesoterodine was associated with a reduction in total incontinence episodes/day and urgency incontinence episodes/day at the end of the open label study [adjusted mean (standard error (SE)) 4.6 (0.12) to 1.2 (0.13) and 3.9 (0.11) to 0.9 (0.11) respectively, p-value<.0001 for both]. Most women were satisfied with treatment (89%, 92%, and 93% at 3, 6, and 9 months). Twenty-six women experienced 28 serious adverse events, one of which was considered possibly treatmentrelated. Twenty-two women had specialist evaluation: 5 women's incontinence was misclassified by the 3IQ; none experienced harm due to misclassification.Conclusions-Using a simple validated questionnaire to diagnose and initiate treatment for UUI in community dwelling women is safe and effective, allowing timely treatment by primary care practitioners.

Guideline of guidelines: urinary incontinence in women

“…The EAU gives a ‘Strong’ recommendation for the use of a validated and appropriate questionnaire in standardised assessments, i.e., to monitor a change after an intervention. In their literature review, they found that some questionnaires (Questionnaire for Urinary Incontinence Diagnosis [QUID], Three Incontinence Questions Questionnaire [3IQ]) have the potential to discriminate UI types in women , whereas in men the ICIQ Urinary Incontinence Short Form (ICIQ‐UI‐SF) has been found not to differentiate UI types . The EAU acknowledged that many studies looking at the validity and reliability of urinary symptom questionnaires were done in patients without UI, and there was no evidence to show that these questionnaires have an impact on treatment outcomes for UI.…”

Regenerative potential of human dental pulp stem cells in the treatment of stress urinary incontinence: In vitro and in vivo study

“…The evaluation of the presence and degree of incontinence must be done through an accurate diagnostic procedure. It may be necessary to collect the patient's medical history, perform a thorough physical examination, use specific and validated questionnaires differentiated for male and female, obtain completed voiding diaries, exclude urinary infections, evaluate post‐void residual volume, perform urodynamic testing, pad testing and imaging …”

The world is upside down; how coronavirus changes the way we care for our patients

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