Predictors of Success and Satisfaction of Nonsurgical Therapy for Stress Urinary Incontinence

Abstract

Objective To identify factors that may predict success and satisfaction in women undergoing nonsurgical therapy for stress urinary incontinence (SUI). Methods Baseline demographic and clinical characteristics of women participating in a multicenter randomized trial of pessary, behavioral, or combined therapy for SUI were evaluated for potential predictors of success and satisfaction. Success and satisfaction outcomes were assessed at 3 months and included the Patient Global Impression of Improvement (PGI-I), stress incontinence subscale of the Pelvic Floor Distress Inventory (PFDI), and Patient Satisfaction Questionnaire (PSQ). Logistic regression was performed to identify predictors, adjusting for treatment and other important clinical covariates. Adjusted odds ratios (AOR), 95% confidence intervals (CI), and associated P-values are presented. Results Four hundred forty-six women were randomized. College education or higher and no previous UI surgery predicted success based on the stress subscale of the PFDI (AOR=1.61, 95% CI 1.01 to 2.55; p=0.04; AOR=3.15, 95% CI 1.04 to 9.53; p=0.04, respectively). Menopausal status predicted success using the PGI-I (AOR=2.52 postmenopausal vs premenopausal, 95% CI 1.29 to 4.95; AOR=1.32 unsure menopausal status vs pre-menopausal, 95% CI 0.65 to 2.66; p=0.03 across all three groups). Less than 14 incontinence episodes per week predicted satisfaction with the PSQ (AOR=1.97, 1.21 to 3.19; p=0.01). These predictors did not differ across the three treatment groups. Conclusions Menopause, higher education, no previous UI surgery and lower incontinence frequency were found to be predictors of success and satisfaction with nonsurgical therapy for SUI. This information may help better align provider and patient expectations with nonsurgical treatment outcomes. Clinical Trial Registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT00270998.

Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year

“…The third outcome, sufficient treatment, is important from a clinical perspective and reflects the patient’s goal of treatment, a recommended part of the composite end-points [22]. The possible predictors were chosen based on risk factors or findings from other studies [5, 6, 11, 12, 18–20, 23]. The percentage of women who underwent incontinence surgery during follow-up (3.0 %) was lower in our study than in other long-term studies (4.9–58 %) [10].…”

“…This description fits our study population and may be problematic for generalizing the results because of the high education level. In short-term predictor studies, both higher [11] and lower [20] education have been described as predictors of a successful result. However, in our study, education was not a predictor in any of the logistic regression analyses.…”

“…The literature on severity as a short-term predictor has reported inconsistent results, with some studies reporting that patients with a higher incontinence frequency have poorer outcomes [11, 18, 20]. However, Hung et al reported that women with more severe incontinence at baseline are more likely to be successful, based on self-reported results [12].…”

“…The possible predictors of long-term success we chose to analyze included known risk factors for SUI [5–7] and suggested predictors from short-term results [11, 12, 18–20]. Because short-term success likely affects long-term success, we included data from the 4-month follow-up [10].…”

“…Suggested predictors of a positive result at 3 months are menopause, higher education, no previous urinary incontinence surgery [11], poor contraction strength at baseline, and great improvement in pelvic floor muscle strength [12]. There is limited knowledge on the predictors of long-term outcome, which could be useful for both patients and clinicians for predicting in whom PFMT will be successful and who will need surgery.…”