Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kegel A (1948) Progressive resistance exercise in the functional restoration of the perineal muscles. Am J Obstet Gynecol 56:238–249

    CAS  PubMed  Google Scholar 

  2. Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev (1):CD005654

  3. Imamura M, Abrams P, Bain C, Buckley B, Cardozo L, Cody J et al (2010) Systematic review and economic modelling of the effectiveness and cost-effectiveness stress urinary incontinence. Health Technol Assess 14(40):1–506

    Article  CAS  PubMed  Google Scholar 

  4. Ogah J, Cody J, Rogerson L (2010) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev (1):CD006375

  5. Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V et al (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary. Eur Urol 58(2):218–238

    Article  PubMed  Google Scholar 

  6. Labrie J, Berghmans LCM, Fischer K, Milani AL, van der Wijk I, Smalbraak DJC et al (2013) Surgery versus physiotherapy for stress urinary incontinence. N Engl J Med 369(12):1124–1133

    Article  CAS  PubMed  Google Scholar 

  7. Cammu H, Van Nylen M, Blockeel C, Kaufman L, Amy JJ (2004) Who will benefit from pelvic floor muscle training for stress urinary incontinence? Am J Obstet Gynecol 191(4):1152–1157

    Article  PubMed  Google Scholar 

  8. Bø K, Kvarstein B, Nygaard I (2005) Lower urinary tract symptoms and pelvic floor muscle exercise adherence after 15 years. Obstet Gynecol 105(5 Pt 1):999–1005

    Article  PubMed  Google Scholar 

  9. Burgio K, Goode PS, Locher JL, Richter HE, Roth L, Clark-Wright K et al (2003) Predictors of outcome in the behavioral treatment of urinary incontinence in women. Obstet Gynecol 102(5):940–947

    Article  PubMed  Google Scholar 

  10. Hendriks EJM, Kessels AGH, Vet HCWD, Bernards ATM, Bie RAD (2010) Prognostic indicators of poor short-term outcome of physiotherapy intervention in women with stress urinary incontinence. Neurourol Urodyn 343:336–343

    Google Scholar 

  11. Truijen G, Wyndaele JJ, Weyler J (2001) Conservative treatment of stress urinary incontinence in women: who will benefit? Int Urogynecol J Pelvic Floor Dysfunct 12(6):386–390

    Article  CAS  PubMed  Google Scholar 

  12. Theofrastous JP, Wyman JF, Bump RC, McClish DK, Elser DM, Bland DR et al (2002) Effects of pelvic floor muscle training on strength and predictors of response in the treatment of urinary incontinence. Neurourol Urodyn 21(5):486–490

    Article  CAS  PubMed  Google Scholar 

  13. Labrie J, van der Graaf Y, Buskens E, Tiersma ESM, van der Vaart CH (2009) Protocol for Physiotherapy Or TVT Randomised Efficacy Trial (PORTRET): a multicentre randomised controlled trial to assess the cost-effectiveness of the tension free vaginal tape versus pelvic floor muscle training in women with symptomatic moderate to se. BMC Women’s Health 9(24)

  14. Bernards ATM, Berghmans LCM, Van Heeswijk-Faase IC, Westerik-Verschuuren EHML, de Gee-de Ridder I, Groot JAM et al (2011) KNGF-richtlijn Stress Urine-Incontinentie. Ned Tjjdschr Fysiother. Jaargang 121 Nr 3, Supplement

  15. Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H (1993) Validation of incontinence severity index in female urinary implementation in an epidemiological survey. Management 497–9

  16. van der Vaart CH, de Leeuw JRJ, Roovers JPWR, Heintz APM (2003) Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited. Neurourol Urodyn 22(2):97–104

    Article  PubMed  Google Scholar 

  17. Yalcin I, Bump R (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189(1):98–101

    Article  PubMed  Google Scholar 

  18. van Houwelingen JC, Le Cessie S (1990) Predictive value of statistical models. Stat Med 9:1303–1325

    Article  PubMed  Google Scholar 

  19. Weinberger MW, Goodman BM, Carnes M (1999) Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women. J Gerontol A Biol Sci Med Sci 54(3):M117–M121

    Article  CAS  PubMed  Google Scholar 

  20. Schaffer J, Nager CW, Xiang F, Borello-France D, Bradley CS, Wu JM et al (2012) Predictors of success and satisfaction of nonsurgical therapy for stress urinary incontinence. Obstet Gynecol 120(1):91–97

    Article  PubMed Central  PubMed  Google Scholar 

  21. Haynes RB, Sackett DL, Guyatt GH, Tugwell P (2006) Clinical epidemiology: how to do clinical practice research, 3rd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  22. Steyerberg EW, Eijkemans MJ, Harrell FE Jr, Habbema JDF (2000) Prognostic modelling with logistic regression analysis: a comparison of selection and estimation methods in small data sets. Stat Med 19:1059–1079

    Article  CAS  PubMed  Google Scholar 

  23. Steyerberg EW, Eijkemans MJ, Van Houwelingen JC, Lee KL, Habbema JD (2000) Prognostic models based on literature and individual patient data in logistic regression analysis. Stat Med 19:141–160

    Article  CAS  PubMed  Google Scholar 

  24. Subak LL, Quesenberry CP, Posner SF, Cattolica E, Soghikian K (2002) The effect of behavioral therapy on urinary incontinence: a randomized controlled trial. Obstet Gynecol 100:72–78

    Article  PubMed  Google Scholar 

  25. Smith DB, Boileau MA, Buan LD (2000) A self-directed home biofeedback system for women with symptoms of stress, urge, and mixed incontinence. S J Wound Ostomy Continence Nurs 27(4):240–246

    Google Scholar 

Download references

Acknowledgments

On behalf of the PORTRET study group: listed at the end of the main body of the text.

Funded with a grant by Zon MW, the Netherlands Organization for Health Research and Development. Trial Registration: Dutch Trial Register number, NTR1248

We would like to acknowledge all participating gynecologists in the PORTRET study group in collaboration with the Dutch urogynecological consortium:

A.L. Milani MD, PhD, Reinier de Graaf Gasthuis

I. v/d Wijk MD, Groene Hart Hospital

D.J.C. Smalbraak MD, Amphia Hospital

R.A. Hakvoort MD, PhD and A. Vollebreg, MD, PhD, Spaarne Hospital

M.H. Kerkhof MD and R.P. Schellart, Kennemer Gasthuis

G.C.M. Graziosi MD, PhD, Sint Antonius Hospital

J.M. v/d Ploeg MD, Martini Hospital

J.F.G.M. Brouns MD, PhD, Zaans Medical Centre,

E.S.M. Tiersma, Vrije Universiteit Medical Centre

A.G. Groenendijk MD, PhD, Onze Lieve Vrouwen Gasthuis

P.C. Scholten MD, PhD, Diakonessenhuis

B.W. Mol MD, PhD, Academic Medical Centre Amsterdam

E.E. Blokhuis MD, Zuwe Hofpoort Hospital

A.H. Adriaanse MD, PhD, Medical Centre Alkmaar

A. Schram MD, PhD, University Medical Centre Groningen

J.P.W.R. Roovers MD, PhD, Academic Medical Centre Amsterdam

Conflict of interest

None

Author information

Authors and Affiliations

  1. University Medical Centre Utrecht, Room: F05.121, Heidelberglaan 100, PO Box 85500, 3508, GA, Utrecht, The Netherlands

    J. Labrie, K. Fischer & C. H. van der Vaart

  2. University Medical Centre Nijgemen, PO Box 9101, 6500, HB, Nijmegen, The Netherlands

    A. L. M. Lagro-Janssen

  3. University Medical Centre Maastricht, PO Box 5800, 6202, AZ, Maastricht, The Netherlands

    L. C. M. Berghmans

Authors
  1. J. Labrie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. L. M. Lagro-Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. C. M. Berghmans
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. H. van der Vaart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Labrie.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Labrie, J., Lagro-Janssen, A.L.M., Fischer, K. et al. Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence. Int Urogynecol J 26, 329–334 (2015). https://doi.org/10.1007/s00192-014-2473-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-014-2473-z

Keywords

Search

Navigation