Racial Differences in Pelvic Anatomy by Magnetic Resonance Imaging

Introduction and Objective

Surgery is a common treatment for stress urinary incontinence (SUI) that is expected both to relieve UI symptoms and improve health related quality of life (HRQOL).

Factors related to HRQOL were assessed in women scheduled for SUI surgery in a randomized clinical trial (Burch retropubic urethropexy versus autologous rectus fascial sling) to identify those factors that might improve after surgery.

Methods

HRQOL was measured at baseline in 665 women with predominant SUI (mean age 51.9 yrs, SD 10.3yrs) with the Incontinence Impact Questionnaire (IIQ), a condition-specific measure of HRQOL that assesses the impact of UI on activities, roles, and emotional states. The relationship between HRQOL and several variables was explored using stepwise multivariable regression analyses. Independent variables were entered into the model in the following steps: sociodemographic factors (age, ethnicity, socioeconomic status), clinical measurements (BMI, pelvic organ prolapse stage), health status and history (fecal incontinence, current smoking, urinary tract infections [UTIs], previous UI treatment), and UI symptoms (mean number of accidents, stress UI symptoms, urge UI symptoms, UI symptom bother). The final model was repeated in the subgroup of sexually active women (n=430), adding a UI-specific measure of sexual function (PISQ-12) to assess the additive effect of sexual function in explaining variability in HRQOL.

Results

Diminished UI-specific HRQOL was related to a higher number of UI episodes/day, more frequent SUI symptoms, greater UI symptom bother, previous UI treatment, greater BMI, current smoking, and was more likely in women who were younger, of lower social class, and Hispanic (all p<.05). The results of this model for all women show that 46% of the variability in HRQOL is explained by these variables. For the sexually active women in the sample, greater UI-related sexual dysfunction was associated with lower HRQOL (p<.001) and explained 8% of the total 54% variance in HRQOL for this sub-group.

Conclusions

The HRQOL related to SUI in women prior to surgery for this condition was associated with three factors that are expected to change with surgery, i.e., higher frequency of UI episodes, more frequent SUI symptoms, greater UI symptom bother, and UI-related sexual dysfunction. The patient’s subjective assessment, as measured by valid disease-specific quality of life instruments, may be as, if not more, important than objective clinical findings in defining success of surgery for SUI.

(Supported by grants from the NIDDK of NIH)

Keywords

Urinary incontinence, quality of life, women

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