A comparison of the objective and subjective outcomes of colposuspension for stress incontinence in women

Objectives To investigate the impact of colposuspension for stress incontin ence on the symptoms and quality of life of women undergoing both primary a nd repeat surgery for genuine stress incontinence and in addition to assess the use of a condition specific quality of life questionnaire as an outcom e measure following surgery. Design Prospective case series: videocystourethrography performed before an d between six and twelve months after surgery. Validated condition specific quality of life (QoL) questionnaires completed by women before and six to twelve months after surgery. Setting A tertiary referral Urogynaecology Unit in a teaching hospital. Participants A consecutive series of 83 women undergoing colposuspension be tween March 1995 and December 1997. Pre-operative assessment and surgery wa s performed by, or was under the direct supervision of, the unit director. Intervention Modified Burch colposuspension. Main outcome measures Objective results of surgery assessed with videocysto urethrography. Subjective results evaluated using a condition specific QoL tool, the Kings Health Questionnaire (KHQ). Symptom severity was evaluated as a component of the condition specific QoL questionnaire. Results Objective cure was demonstrated in 92% of women undergoing primary surgery with an 8% incidence of de-novo detrusor instability and a 10% inci dence of voiding difficulties. In the group of women having repeat surgery the objective cure rate was 81% with no de-novo detrusor instability and a 6% incidence of post-operative voiding difficulties. QoL scores improved in 95% of women. Improvements of over 25% were seen in 70% of women and of ov er 50% in 28%. However, 2.4% of women recorded a deterioration in QoL score s. Conclusions Colposuspension performed in this setting, assessed using both objective and standardised subjective measures, completed by women themselv es, appears to produce good objective and subjective results and leads to e nhanced quality of life in the great majority of women.