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Clinical criterion validation of self reported urinary incontinence
TUESDAY,
SEPTEMBER
FC2.29 UROGYNECOLOGY:
5
75
BIOLOGY AND DIAGNOSIS
FC2.29.01 ONE-YEAR FOLLOW-UP STUDY OF URINARY INCONTINENCE IN WOMEN 40-60 YEARS OF AGE LA Moller, G Lose, Depts of OB/GYN. & Preventive Medicine, County Hospital of Glostrup, University Hospital of Copenhagen, Glostrup, Denmark To study the natural history of urinary incontinence in women 40-60 years of age. A validated and tested/retested questionnaire was sent to 4,000 women randomly recruited from the Civil Registration System in Denmark. Incidence and remission rates were defined as the transitions from continent to incontinent among continent women and the transitions from incontinent to continent among incontinent women, respectively. Inclusion rates = 71.7% (baseline) and = 57.0% (one-year follow-up), respectively. Baseline study One-year follow-up study Symptoms weekly Remission Prevalence rates Incidence rates or more: rates Stress incontinence 13,l 44,6 4,5 Urge incontinence 46,E 7,3 3,2 Other types 50,9 4,9 I,9 of incontinence* One or more types 16,4 41,2 6,4 of incontinence * Nocturnal enuresis, overflow incontinence and/or sexual incontinence Conclusions: Urinary incontinence is a common reported, but inconsistent symptom among women of age 40-60 years.
FC2.29.02 3D-ULTRASOUND DIAGNOSTICS IN THE DETERMINATION OF NORMAL BLADDER ANATOMY AND AT THE INCONTINENCE V.I. Krasnouolskii, L. I. Titchenko, M. A. Chechneva, N. V. Dub, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia Objective: The aim of this study was to assess the condition of the bladder and urethra using 3D-Ultrasound at normal and at the incontinence. Methods: 30 healthy women and 60 women with incontinence were examined at age 20-60 years. Results: Proximal urethra diameter was 0.55 cm (at mean) and area of proximal part of urethra 0.20 - 0.26 cm’. The width of urethral sphincter was 0.49 cm (at mean). The correlation between width of urethral sphincter in women who gave birth and who did not give birth was not significant. Proximal urethra diameter was l.Ocm and on area of proximal part of urethra was 0.54cmz for those with incontinence. The width of urethral sphincter in those with incontinence was 0.2 cm. The sphincter was deformed at the incontinence in 80% of cases. Index of ratio of the width of urethral sphincters by one area of the urethra in healthy women was 0.4-0.7, and at the incontinence was >l. Conclusions: 3D-Ultrasound gives new diagnostic possibilities in urogicoligi.
FC2.29.03 CLINICAL CRITERION VALIDATION OF SELF REPORTED URINARY INCONTINENCE L. Hvidman, Dept. EPID/SOC, University of Aarhus, and Dept. OB/GYN, University Hospital Aarhus, Skejby, DENMARK. A. Foldspang, Dept. EPID/SOC, University of Aarhus, DENMARK. S. Mommen, Dept. UROL, Randers Hospital, DENMARK. Objectives: The aim of the present study was to estimate (1) the validity of a self-administered questionnaire concerning presence of urinary incontinence (UI) and (2) the population prevalence of UI, based on clinical interview. Study methods: A sub-sample of 101 women drawn from a population sample of 4710 women aged 20-59 years, filled out a questionnaire on urinary incontinence. Afterwards a trained gynecologist blinded to
questionnaire information made a clinical interview, Main results: Overall agreement between questionnaire-U1 and clinical assessment was 85.1%. Test-parameters for Stress UI: Predictive value of a positive test 70.0%, predictive value of a negative test 79.3%, sensitivity 56.7% and specificity 87.2%. From the sub-sample the population prevalence of clinical stress UI could be estimated to be 34.5% (22.1-46.9). Conclusion: A self-administered questionnaire on urinary incontinence was found to be a valid observational tool, to a high degree agreeing with the assessment originating from the clinical interview. The weak point was a high proportion of false negatives, stemming from women with few or minor episodes with UI, which remained unidentified by the questionnaire.
FC2.29.04 HISTOLOGICAL FEATURES OF INTERSTITIAL CYSTITIS A Rosamilia, Dept Urogynaecology, Royal Women’s Hospital and Monash Medical Centre. P Dept Urogynaecology, Royal Women’s Hospital and Mercy Hospital for Women. .I Scurry, Dept Pathology, Mercy Hospital for Women, Melbourne, Australia Objective: The aim of the study was to compare the histological features of bladder biopsies from women with interstitial cystitis ( IC )and control subjects. Study Methods: Cold-cup forceps biopsies were taken after standardised bladder hydrodistension in women with IC and after incontinence or prolapse surgery in control subjects. The diagnosis of IC was made using NIDDK criteria. The biopsies were assessed in a blinded manner. The submucosa was assessed in terms of degree of oedema, vascular congestion or ectasia, inflammatory infiltrate and haemorrhage. Each of these were scored 0 to 3. The four scores were added to give the composite abnormal histology score. Results: Biopsies from 36 women with interstitial cystitis and 43 control subjects were analysed. The epithelium was completely denuded in 22 % of IC subjects and no controls. Regression analysis demonstrated that the distribution of IC was different to controls with respect to both the abnormal histology score and the degree of vascular congestion and ectasia (both analyses; chi-square p
FC2.29.05 ULTRASONIC, U.S., ASSESSMENT OF THE INTERNAL URETHRAL SPHINCTER IN STRESS URINARY INCONTINENCE, (S.U.I.) I.Kandil, A.E.K. El Hemaly, M.M. Radwan, Dept. OB/GYN, Faculty of Medicine Al Azhar University, Cairo, Egypt Objectives: A new concept was described in 1996 explaining micturition and urinary continence. It depends on a strong, sound and intact internal sphincter, and on an acquired behavior of keeping a high alpha sympathetic tone. Weakness of the internal sphincter causes SUI. Weakness is mostly due to rupture and or split of the wall. U.S. assessment of the internal sphincter is tried. Study Methods: U.S. assessment, 3D, of the internal sphincter is done in 2 groups of women. The first group consists of 20 continent women. The second group consists of 60 patients with SUI who had clinical and urodynamic evaluation. Results: Continent women have linear internal sphincter that extends from the bladder neck for 60.80% of the urethral length. The internal sphincter has a thick symmetrical wall with 3 different echo. In SUI patients, there is irregularity in the wall with areas of echolucency. Conclusions: Vaginal U.S., 3D, assessment of the internal urethral sphincter is very sensitive and specific for the diagnosis of SUI.
SEPTEMBER
FC2.29 UROGYNECOLOGY:
5
75
BIOLOGY AND DIAGNOSIS
FC2.29.01 ONE-YEAR FOLLOW-UP STUDY OF URINARY INCONTINENCE IN WOMEN 40-60 YEARS OF AGE LA Moller, G Lose, Depts of OB/GYN. & Preventive Medicine, County Hospital of Glostrup, University Hospital of Copenhagen, Glostrup, Denmark To study the natural history of urinary incontinence in women 40-60 years of age. A validated and tested/retested questionnaire was sent to 4,000 women randomly recruited from the Civil Registration System in Denmark. Incidence and remission rates were defined as the transitions from continent to incontinent among continent women and the transitions from incontinent to continent among incontinent women, respectively. Inclusion rates = 71.7% (baseline) and = 57.0% (one-year follow-up), respectively. Baseline study One-year follow-up study Symptoms weekly Remission Prevalence rates Incidence rates or more: rates Stress incontinence 13,l 44,6 4,5 Urge incontinence 46,E 7,3 3,2 Other types 50,9 4,9 I,9 of incontinence* One or more types 16,4 41,2 6,4 of incontinence * Nocturnal enuresis, overflow incontinence and/or sexual incontinence Conclusions: Urinary incontinence is a common reported, but inconsistent symptom among women of age 40-60 years.
FC2.29.02 3D-ULTRASOUND DIAGNOSTICS IN THE DETERMINATION OF NORMAL BLADDER ANATOMY AND AT THE INCONTINENCE V.I. Krasnouolskii, L. I. Titchenko, M. A. Chechneva, N. V. Dub, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia Objective: The aim of this study was to assess the condition of the bladder and urethra using 3D-Ultrasound at normal and at the incontinence. Methods: 30 healthy women and 60 women with incontinence were examined at age 20-60 years. Results: Proximal urethra diameter was 0.55 cm (at mean) and area of proximal part of urethra 0.20 - 0.26 cm’. The width of urethral sphincter was 0.49 cm (at mean). The correlation between width of urethral sphincter in women who gave birth and who did not give birth was not significant. Proximal urethra diameter was l.Ocm and on area of proximal part of urethra was 0.54cmz for those with incontinence. The width of urethral sphincter in those with incontinence was 0.2 cm. The sphincter was deformed at the incontinence in 80% of cases. Index of ratio of the width of urethral sphincters by one area of the urethra in healthy women was 0.4-0.7, and at the incontinence was >l. Conclusions: 3D-Ultrasound gives new diagnostic possibilities in urogicoligi.
FC2.29.03 CLINICAL CRITERION VALIDATION OF SELF REPORTED URINARY INCONTINENCE L. Hvidman, Dept. EPID/SOC, University of Aarhus, and Dept. OB/GYN, University Hospital Aarhus, Skejby, DENMARK. A. Foldspang, Dept. EPID/SOC, University of Aarhus, DENMARK. S. Mommen, Dept. UROL, Randers Hospital, DENMARK. Objectives: The aim of the present study was to estimate (1) the validity of a self-administered questionnaire concerning presence of urinary incontinence (UI) and (2) the population prevalence of UI, based on clinical interview. Study methods: A sub-sample of 101 women drawn from a population sample of 4710 women aged 20-59 years, filled out a questionnaire on urinary incontinence. Afterwards a trained gynecologist blinded to
questionnaire information made a clinical interview, Main results: Overall agreement between questionnaire-U1 and clinical assessment was 85.1%. Test-parameters for Stress UI: Predictive value of a positive test 70.0%, predictive value of a negative test 79.3%, sensitivity 56.7% and specificity 87.2%. From the sub-sample the population prevalence of clinical stress UI could be estimated to be 34.5% (22.1-46.9). Conclusion: A self-administered questionnaire on urinary incontinence was found to be a valid observational tool, to a high degree agreeing with the assessment originating from the clinical interview. The weak point was a high proportion of false negatives, stemming from women with few or minor episodes with UI, which remained unidentified by the questionnaire.
FC2.29.04 HISTOLOGICAL FEATURES OF INTERSTITIAL CYSTITIS A Rosamilia, Dept Urogynaecology, Royal Women’s Hospital and Monash Medical Centre. P Dept Urogynaecology, Royal Women’s Hospital and Mercy Hospital for Women. .I Scurry, Dept Pathology, Mercy Hospital for Women, Melbourne, Australia Objective: The aim of the study was to compare the histological features of bladder biopsies from women with interstitial cystitis ( IC )and control subjects. Study Methods: Cold-cup forceps biopsies were taken after standardised bladder hydrodistension in women with IC and after incontinence or prolapse surgery in control subjects. The diagnosis of IC was made using NIDDK criteria. The biopsies were assessed in a blinded manner. The submucosa was assessed in terms of degree of oedema, vascular congestion or ectasia, inflammatory infiltrate and haemorrhage. Each of these were scored 0 to 3. The four scores were added to give the composite abnormal histology score. Results: Biopsies from 36 women with interstitial cystitis and 43 control subjects were analysed. The epithelium was completely denuded in 22 % of IC subjects and no controls. Regression analysis demonstrated that the distribution of IC was different to controls with respect to both the abnormal histology score and the degree of vascular congestion and ectasia (both analyses; chi-square p
FC2.29.05 ULTRASONIC, U.S., ASSESSMENT OF THE INTERNAL URETHRAL SPHINCTER IN STRESS URINARY INCONTINENCE, (S.U.I.) I.Kandil, A.E.K. El Hemaly, M.M. Radwan, Dept. OB/GYN, Faculty of Medicine Al Azhar University, Cairo, Egypt Objectives: A new concept was described in 1996 explaining micturition and urinary continence. It depends on a strong, sound and intact internal sphincter, and on an acquired behavior of keeping a high alpha sympathetic tone. Weakness of the internal sphincter causes SUI. Weakness is mostly due to rupture and or split of the wall. U.S. assessment of the internal sphincter is tried. Study Methods: U.S. assessment, 3D, of the internal sphincter is done in 2 groups of women. The first group consists of 20 continent women. The second group consists of 60 patients with SUI who had clinical and urodynamic evaluation. Results: Continent women have linear internal sphincter that extends from the bladder neck for 60.80% of the urethral length. The internal sphincter has a thick symmetrical wall with 3 different echo. In SUI patients, there is irregularity in the wall with areas of echolucency. Conclusions: Vaginal U.S., 3D, assessment of the internal urethral sphincter is very sensitive and specific for the diagnosis of SUI.