Does Self Reported Pad Use Following Pubovaginal Sling Surgery Accurately Reflect Patient Quality of Life?


Introduction: Pad use per day is a controversial endpoint for measuring urinary incontinence severity. Our objective was to determine if pad use could be used as a proxy measurement assessing patient quality of life after pubovaginal sling surgery (PVS).

Methods: Women treated with PVS for symptomatic stress incontinence between June 1998 and April 2005 were identified from surgical case logs. Chart review was performed for demographic, surgical, and post operative data. Patients reporting 0 pads per day usage before surgery were excluded. Surgical outcome was determined by patient self-assessment and included urinary specific validated symptom and impact quality of life questionnaires. All patients were asked to complete the short version of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire 7 (IIQ-7), before and the procedure and during subsequent follow-up visits. At each post operative visit, each subject was instructed to record the number of times a protective urinary pad was changed per day over the past 3 days due to bothersome moisture. The change in total UDI-6 and IIQ-7 scores after PVS was calculated for each subject based on last follow up assessment. ANOVA and Pearson correlation tests were used to assess the change in UDI-6 and IIQ-7 scores for patients reporting changing 0, 1, 2, and 3 or more urinary pads per day.

Results: Data was available on 216 women. Mean age at time of surgery was 58 years and mean pre operative IIQ7 and UDI6 scores were 13.9 and 11.9. Over a mean 8.5 months follow up, 132, 56, 16, and 12 women reported 0, 1, 2, and 3 or more pad changes/day, respectively. Change in both UDI6 and IIQ7 scores showed statistically less improvement for each successive pad use group: Figure 1.

Both change in IIQ7 score (r = -0.30, p < 0.0001) and UDI6 score (r = -0.33, p < 0.0001) negatively correlated with pad use per day. There were no significant differences between preoperative IIQ or UDI scores between pad groups prior to PVS.

Conclusions: Urinary specific quality of life was significantly different between women reporting 0, 1, 2 or > 3 pads/day usage after PVS. Pad use per day can give a proxy quality of life assessment after PVS.

KEYWORDS: Pubovaginal sling, pad use, incontinence