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A holistic view of urinary stress incontinence in women
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
1995 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The present study group consists of 45 women with genuine stress incontinence who were selected for surgical treatment and randomized either to retropubic urethrocystopexy (n=30) or pubococcygeal repair (n=15). The preoperative assessment included medical history, gynecological examination, urine analysis and culture, residual urine, pad test, frequency-continence charts, water urethrocystoscopy, continence test and cystometry with analysis of micturition. Moreover, five semistructured interviews were performed with the women and two with their partner. The following questionnaires were used measuring a) personality characteristics: Karolinska Scales of Personality (KSP), Eysenck Personality Inventory (EPI), b) depression: Beck Depression Inventory (BDI) and c) social support: Interview Schedule for Social Interaction (ISSI).

The results have shown that there was no difference in the subjective cure rate between the two surgical methods (73% vs. 80 % respectively). The bladder volume had increased in both groups and the intravesical pressure of the bladder filled to maximum had increased in the pubococcygeal repair group. Other urodynamic variables were unchanged by the operation. Pad tests have demonstrated that 67 % of the women in the urethrocystopexy group and 47 % in the pubococcygeal repair group ceased to leak urine. Postoperatively, 63 % of the women in the urethrocystopexy group needed high doses of analgesics compared with only 33 % in the pubococcygeal repair group. Among the women experiencing severe to very severe pain dysphoric subjects were overrepresented. Postoperative residual urine was a minor nursing problem in both groups.

Women with SUI of long duration scored significantly higher than controls on the KSP scales of somatic anxiety, psychic anxiety, psychasthenia, suspicion and on the EPI lie-scale. There was no significant difference in sexual activity before and after surgery. One or two sexual dysfunctions within the desire, excitement, orgasmic and resolution phase were reported by the majority of women both before and after surgical intervention.

The cured women reported a higher level of overall activities before surgery than the improved (i.e. not cured) women, whereas post surgery both the cured and the improved women obtained about the same level of activities. Regarding social support, no differences between the cured or improved women occured as concerns attachment. The cured women showed a higher degree of adequacy of social integration compared with the improved women.

In order to delineate predictive factors for the surgical outcome the following variables were investigated: age of patient, duration of urine leakage, parity, personality, psychological and social factors. The following predictors of the outcome of surgical treatment emerged: duration of stress incontinence, neuroticism and age of patient.

The results of the present study indicate the ecessity of a multidisciplinary approach to the treatment and nursing of women with SUI.

Place, publisher, year, edition, pages
Umeå: Umeå University , 1995. , 41 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 443
Keyword [en]
Stress urinary incontinence, surgical treatment, urodynamics, pad test, nursing, personality characteristics, leisure time, spouse relationship, sexuality, social network, predictors, outcome
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:umu:diva-96892ISBN: 91-7191-086-7 (print)OAI: oai:DiVA.org:umu-96892DiVA: diva2:769094
Public defence
1995-09-22, Rosa salen, 9 tr, Tandläkarhögskolan i Umeå, Umeå universitet, Umeå, 09:00
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 1995

Available from: 2015-01-20 Created: 2014-12-05 Last updated: 2015-04-08Bibliographically approved
List of papers
1. Urodynamics in women with stress incontinence before and after surgery
Open this publication in new window or tab >>Urodynamics in women with stress incontinence before and after surgery
1993 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 48, no 3, 197-205 p.Article in journal (Refereed) Published
Abstract [en]

Pad test, cystometry and analysis of micturition were performed in 36 women with stress incontinence before and a year after operation with either retropubic urethrocystopexy (n = 22) or pubococcygeal repair (n = 14). There was no difference in the subjective cure rate between the two groups of women (77% and 79%, respectively). The pad test 1 year after operation showed that 59% of the women in the urethrocystopexy group and 43% of the women in the pubococcygeal repair group had stopped leaking urine. The bladder volume had increased in both groups and the intravesical pressure of the bladder filled to the maximum had increased in the pubococcygeal repair group. The functional length of the urethra, intravesical pressure at maximal urine flow, maximal urine flow rate and urethral conductance were not affected by either operation. Pad test was a more accurate test for an objective evaluation of urine leakage before operation than were the urodynamic investigation or continence tests.

Place, publisher, year, edition, pages
Elsevier, 1993
Keyword
Urinary stress incontinence, Urodynamics, Pad test, Surgical treatment
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-98411 (URN)10.1016/002822439390088-T (DOI)
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2017-12-05Bibliographically approved
2. Personality characteristics of-A stress incontinent women: a pilot study
Open this publication in new window or tab >>Personality characteristics of-A stress incontinent women: a pilot study
1994 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 15, no 3, 165-170 p.Article in journal (Refereed) Published
Abstract [en]

Personality traits were assessed by means of the Karolinska Scale of Personality (KSP) and the Eysenck Personality Inventory (EPI) in 45 genuine stress incontinent women and compared with a reference group of continent women in order to investigate the possible impact of this chronic condition on the personality. Women with stress incontinence of long duration scored significantly higher than controls on the KSP scales somatic anxiety, psychic anxiety, psychasthenia and suspicion and on the EPI lie-scale. These findings point to the importance of personality factors in chronic conditions such as urinary incontinence.

Place, publisher, year, edition, pages
Informa Healthcare, 1994
Keyword
Stress Urinary Incontinence, Personality Traits
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-98412 (URN)10.3109/01674829409025642 (DOI)
Conference
2015/01/22
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2017-12-05Bibliographically approved
3. The pre- and postsurgical nursing of women with stress incontinence
Open this publication in new window or tab >>The pre- and postsurgical nursing of women with stress incontinence
1996 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 23, no 3, 502-511 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to evaluate subjective and objective methods used for the investigation of stress urinary incontinence (SUI) and to compare the outcome of two different surgical techniques regarding cure rate, postoperative nursing, bladder drainage and postoperative pain relief. The study included 45 women with SUI, randomized either to retropubic urethrocystopexy (n = 30) or pubococcygeal repair (n = 15). The assessment included medical history, gynaecological examination, urine analysis and culture, residual urine, pad test, frequency-continence charts, water urethrocystoscopy, continence test, and cystometry with micturition analysis. Moreover, Beck's Depression Inventory and the Eysenck Personality Inventory were used before surgery. One year after surgery no significant difference in subjective cure rate was found between the two surgical methods (73% vs. 80%, respectively). According to pad tests, 67% of the women in the urethrocystopexy group and 47% in the pubococcygeal repair group had ceased to leak urine. The bladder volume increased significantly in both groups. Sixty-three per cent of the women in the urethrocystopexy and 33% in the pubococcygeal repair group experienced severe to very severe postoperative pain. In these groups, significantly more dysphoric women were found as compared with the group of women with less postoperative pain. Furthermore, the women with more severe pain scored higher on the neuroticism scale. These findings indicate the importance of personality factors in the treatment and nursing of women with SUI.

Place, publisher, year, edition, pages
Wiley-Blackwell, 1996
Keyword
Stress Incontinence -- Surgery, Postoperative Care, Medical-Surgical Nursing, Personality Tests, Funding Source, Sweden, Random Assignment, Clinical Research, Wilcoxon Signed Rank Test, Chi Square Test, Beck Depression Inventory, Revised Edition, Prospective Studies, Outcomes Research, Descriptive Statistics, Surgery, Urogenital -- Methods, Postoperative Pain, Urodynamics -- Evaluation, Preoperative Care, Adult, Middle Age, Female, Human
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-98418 (URN)10.1111/j.1365-2648.1996.tb00012.x (DOI)8655825 (PubMedID)
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2017-12-05Bibliographically approved
4. Some Sexological Characteristics of Stress Incontinent Women
Open this publication in new window or tab >>Some Sexological Characteristics of Stress Incontinent Women
1996 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 30, no 3, 207-212 p.Article in journal (Refereed) Published
Abstract [en]

Forty-four women with stress urinary incontinence (SUI) were interviewed in order to investigate sexual activities, sexual function and satisfaction one month before and one year after either one of two possible surgical interventions. The findings were related to sexual response cycle, size of urinary leakage, duration of incontinence and depression. There was no significant difference in sexual activity before and after surgery. One or two sexual dysfunctions within the desire, excitement, orgasmic and resolution phases were reported by the majority both before and after intervention independently of surgical method. Neither the magnitude of the leakage nor the duration of SUI influenced the sexual experiences significantly while continence after surgery promoted sexual desire. The discrepances between the prevalence of sexual dysfunctions and the relatively high level of sexual satisfaction as well as the non-influencing parameters indicate the complexity of human sexuality.

Place, publisher, year, edition, pages
Informa Healthcare, 1996
Keyword
Urinary incontinence, sexual activity
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-98470 (URN)10.3109/00365599609181301 (DOI)
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2017-12-05Bibliographically approved
5. Social adjustment and spouse relationships among women with stress incontinence before and after surgical treatment
Open this publication in new window or tab >>Social adjustment and spouse relationships among women with stress incontinence before and after surgical treatment
1996 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 42, no 11, 1537-1544 p.Article in journal (Refereed) Published
Abstract [en]

Forty-five women with stress urinary incontinence (SUI) and their partners have been interviewed three months before and one year after surgical treatment to investigate the social consequences of their impairment. One year after surgery 76% of the women reported that they were cured (group A, n = 34) and 24% that they were improved (group B, n = 11). The cured women were significantly younger than the improved women. The duration of urinary leakage before the operation was significantly shorter in group A than in group B. One year post surgery group A reported a significantly decrease in impediments to exert certain tasks due to urine leakage. As concerns leisure time, group A reported a higher level of overall activities before surgery than group B, whereas postsurgery both groups obtained about the same level of activities. Regarding social support, no differences between the groups occurred as concerns attachment. Furthermore, group A women showed a significantly higher degree of adequacy of social integration compared with group B. The majority of the couples could openly discuss sexual matters with their partners and were satisfied with their sexual life. More than half of the interviewed men reported an increase in sexual desire one year after their partners operation. Whereas about every third woman in both groups reported an increase in sexual desire. However, the frequency of intercourse did not change in any groups. In conclusion, this study underlines the importance of social factors in the assessment of the consequences of stress urinary incontinence and its treatment.

Keyword
stress urinary incontinence; social adjustment; leisure time; employment; spouse relationship; sexuality; social network
Identifiers
urn:nbn:se:umu:diva-41777 (URN)10.1016/0277-9536(95)00250-2 (DOI)8771636 (PubMedID)
Available from: 2011-04-13 Created: 2011-04-01 Last updated: 2017-12-11Bibliographically approved
6. Predictive factors of the outcome of primary surgical treatment of stress incontinence in women
Open this publication in new window or tab >>Predictive factors of the outcome of primary surgical treatment of stress incontinence in women
1997 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 31, no 1, 49-55 p.Article in journal (Refereed) Published
Abstract [en]

Forty-five women with stress incontinence (mean age 50 years) scheduled for surgical treatment randomized either to retropubic urethrocystopexy or to pubococcygeal repair were prospectively studied. Fifty healthy women were used as a reference group. No difference emerged concerning the outcome for these two surgical techniques in terms of success rate. Consequently, the subjects were treated as one group. The aim of the study was to test for predictive factors of the outcome of surgical treatment. Age of the patient, duration of stress incontinence, parity, personality, psychological and social factors were investigated. The outcome of surgical treatment was estimated both subjectively and objectively (pad test). The women were classified as cured or improved/failure. There was an 80% concordance between subjective and objective methods. In the stress incontinent women who were improved/failure one year after surgery, a high degree of neuroticism, low degree of extraversion, high degree of somatic anxiety, psychic anxiety, psychasthenia and suspicion was observed compared to the cured women. Furthermore, the improved/failure women had a lower level of social integration, in terms of loneliness compared to the cured women. Our findings point to the need of psychosocial support and care in addition to the medical treatment. According to a stepwise logistic regression analysis three variables have been found of importance as predictors of the outcome of the surgical treatment: duration of stress incontinence, neuroticism and age of patient.

Keyword
SUI, surgical treatment, predictive factors
Identifiers
urn:nbn:se:umu:diva-41782 (URN)9060084 (PubMedID)
Available from: 2011-04-01 Created: 2011-04-01 Last updated: 2017-12-11Bibliographically approved

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