A simplified urinary incontinence score for the evaluation of treatment outcomes

There are no standardized definitions for anti-incontinence therapy outcome s. The present study was conducted to evaluate whether the incorporation of several non-invasive outcome measures into a new score may serve as a mean ingful outcome instrument. Ninety-four consecutive sphincteric incontinent women who underwent a pubovaginal sling by a single surgeon were enrolled. All patients underwent a full clinical evaluation, including pre- and post- operative questionnaires, 24-hour voiding diary, and 24-hour pad test. Surg ery out comes were classified twice: First, by analyzing the patient questi onnaire, voiding diary, and pad test separately, according to previously pu blished criteria, and second, by combining the three outcome tools into a n ew response score. The new score was constructed in a simple, easy-re-remem ber format and divided into five categories: cure, good response, fair resp onse, poor response, and failure. All patients were evaluated at least 1 ye ar post-operatively. Comparison of the old and new classifications Suggests that the new response score provides a more accurate evaluation of the sur gical outcomes. Although 64 to 69% of the patients were originally classifi ed as cure according to the old classification, only 44.7% were re-classifi ed as cure by the strict criteria employed in the new score. Furthermore, t he response score also differentiates between various degrees of clinical i mprovement (i.e., good, fair, or poor response). Twenty-five (26.6%) patien ts, most of whom were previously classified as cure, were re-classified as good response, whereas 20 others were re-classified as fair (13.9%), or poo r (7.4%) response. Seven (7.4%) patients were re-classified as surgical fai lures. All were diagnosed pre-operatively as having complex sphincteric inc ontinence. Specific failure rates were therefore 11.3% for complex and 0% f or simple cases. In conclusion, the suggested post-operative response score incorporates in a user-friendly format three popular outcome tools (i.e., 24-hour diary, 24-hour pad test, and patient questionnaire) and seems to re flect the surgical results more accurately. Further studies are needed to a ssess its validity and reproducibility in other treatment modalities. (C) 2 000 Wiley-Liss, Inc.