Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence

• Published in: International Urogynecology Journal Vol. 26; no. 3; pp. 329 - 334
• Main Authors: Labrie, J., Lagro-Janssen, A. L. M., Fischer, K., Berghmans, L. C. M., van der Vaart, C. H.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.03.2015; Springer Nature B.V
• Subjects: Adult; Age Factors; Cross-Over Studies; Decision Support Techniques; Educational Status; Exercise Therapy; Female; Gynecology; Humans; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pelvic Floor; Predictive Value of Tests; Retreatment; Risk Factors; Severity of Illness Index; Suburethral Slings; Treatment Failure; Urinary Incontinence, Stress - surgery; Urinary Incontinence, Stress - therapy; Urology; Pelvic floor muscle training; Predicting; Midurethral sling surgery; Stress urinary incontinence
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-014-2473-z

Introduction and hypothesis To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women. Methods This was a cohort study including women with moderate to severe stress incontinence who were allocated to the physiotherapy arm from a previously reported multicentre trial comparing initial surgery or initial physiotherapy in treating stress urinary incontinence. Crossover to surgery was allowed. Results Data from 198/230 women who were randomized to physiotherapy was available for analysis, of whom 97/198 (49 %) crossed over to surgery. Prognostic factors for undergoing surgery after physiotherapy were age <55 years at baseline (OR 2.87; 95 % CI 1.30–6.32), higher educational level (OR 3.28; 95 % CI 0.80–13.47), severe incontinence at baseline according to the Sandvik index (OR 1.77; 95 % CI 0.95–3.29) and Urogenital Distress Inventory; incontinence domain score (OR 1.03; per point; 95 % CI 1.01–1.65). Furthermore, there was interaction between age <55 years and higher educational level (OR 0.09; 95 % CI 0.02–0.46). Using these variables we constructed a prediction rule to estimate the risk of surgery after initial physiotherapy. Conclusion In women with moderate to severe stress incontinence, individual prediction for surgery after initial physiotherapy is possible, thus enabling shared decision making for the choice between initial conservative or invasive management of stress urinary incontinence.