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(s): Existing bladder-specific measures lack ability to assess a range of bladder health from poor to optimal health. We report evidence for validity of the self-administered, multidimensional Bladder Health Scales and Function Indices for research in adult women.A cross-sectional population-based validation study with random assignment to paper or electronic administration was conducted using national address-based probability sampling supplemented by purposive sampling of women with lower urinary tract symptoms surrounding 7 clinical research centers. Construct validity of the Bladder Health Scales and Function Indices was guided by Multitrait-Multimethod approach using health and condition-specific questionnaires, bladder diaries, expert ratings of bladder health, and noninvasive bladder function testing. Internal dimensional validity was evaluated using factor analysis; internal reliability was assessed using paired t-tests and 2-way mixed effects Intraclass Correlation Coefficient models. Mode comparisons used chi-square, Fisher Exact or t-tests. Convergent validity was evaluated using Pearson correlations with the external construct measures and known-group validity was established with comparison of women known and unknown to be symptomatic with urinary conditions.The sample included 1,072 participants. Factor analysis identified ten scales with Cronbach's alpha ranging 0.74-0.94. Intraclass correlation coefficients of scales ranged from 0.55-0.94. Convergent validity of ten scales and six indices ranged from 0.52- 0.83. Known-group validity was confirmed for all scales and indices. Item distribution was similar by mode of administration.The paper and electronic forms of the Bladder Health Scales and Function Indices are reliable and valid measures of bladder health for use in women's health research.

Objective The aim of this study was to identify factors associated with urinary incontinence severity at baseline in women undergoing surgery for stress incontinence. Study design Baseline data were obtained from 650 women (age 28 to 81 years) with stress incontinence participating in a randomized surgical trial. Severity of incontinence was defined by the mean number of incontinence episodes per day recorded in a 3-day bladder diary. The relationships between severity and several baseline variables were examined, including demographics, medical, obstetric, and gynecologic history, body mass index, smoking status, Q-tip displacement, and Pelvic Organ Prolapse Quantification stage (POP-Q). Results In a multivariable model, severity of incontinence was positively associated with body mass index ( P = .0003) and current smoking ( P = .01), and negatively associated with prolapse stage ( P P = .042). Conclusion Incontinence severity in a surgical population was independently associated with 2 modifiable factors, obesity and tobacco use, as well as pelvic support.

Objective The purpose of this study was to assess a cohort of patients who underwent a colpocleisis procedure more than 1 year post operation to determine: 1) the proportion of patients who regretted having the procedure, 2) patient satisfaction with the procedure, and 3) changes in symptom severity after surgery. Study design Using the University of Alabama at Birmingham (UAB) Genitourinary Disorders Center database, a prospective analysis was performed on 54 patients who underwent colpocleisis between August 1996 and April 2003. From August to October of 2004, participants were contacted by an investigator not involved with the surgery and were asked 1) "do you regret having your surgery, and, if so, why?," 2) "how satisfied are you with your progress (completely, somewhat, or not)?," and 3) to repeat the short form Incontinence Impact Questionnaire/Urogenital Distress Inventory (IIQ-7/UDI-6). Results Fifty-nine percent (32/54) of potential candidates participated in the study. Nine percent (3/32) of patients regretted having colpocleisis performed. Fifty-seven percent (16/28) were completely satisfied, 29% (8/28) somewhat satisfied, and 14% (4/28) not satisfied. Mean IIQ score improved significantly from 40.9 (±31.7) at baseline to 14.1 (±26.7) at last interview ( P = .003). Mean UDI score improved significantly from 63.1 (±24.3) at baseline to 24.2 (±26.7) at last interview ( P = .001). There was a negative correlation between change in UDI scores with time since procedure ( r = −.397, P = .055) and age ( r = −.435, P = .034). Conclusion Few patients reported regret after partial colpocleisis. There was a high rate of patient satisfaction and significant symptom improvement more than a year post surgery. Stable but smaller improvements were reported with longer time from surgery and increasing age.

The purpose of this study was to describe the effects of full-length cadaveric fascia lata (CFL) sling on quality-of-life outcomes.Patients were 102 women (aged 29 to 87 years) who underwent the sling procedure for stress incontinence associated with intrinsic sphincter deficiency. They were followed up at 12, 24, 36, and 48 months with the Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and a patient satisfaction questionnaire.Mean IIQ score declined from 55.1 before surgery to 11.0 at 12 months (P.001). Mean UDI score declined from 67.1 to 28.0 at 12 months (P.01). At 12 months, 79.7% of patients reported that leakage was better or much better, and 90.2% reported that they were somewhat or completely satisfied with their progress. Results were maintained throughout the 48-month follow-up period.The CFL sling procedure has an enduring beneficial effect on lower urinary tract symptoms and quality of life.

The Epidemiologic Issues in Urinary Incontinence: Current Databases and Future Collaborations Symposium included an international group of 29 investigators from 10 countries. The purpose of the symposium was to discuss the current understanding and knowledge gaps of prevalence, incidence, associated risk factors, and treatment outcomes for incontinence in women. During the symposium, investigators identified existing large databases and ongoing studies that provide substantive information on specific incontinence research questions. The investigators were able to form an international collaborative research working group and identify potential collaborative projects to further research on the epidemiology of urinary incontinence and bladder dysfunction.

The objective of the study was to investigate the impact of postpartum fecal incontinence (FI) and urinary incontinence (UI) on quality of life (QOL).Seven hundred fifty-nine primiparous women in the Childbirth and Pelvic Symptoms study were interviewed 6 months postpartum. FI and UI were assessed with validated questionnaires. We measured QOL with SF-12 summary scores, health utility index score (a measure of self-rated overall health), and the modified Manchester Health Questionnaire.Women with FI had worse self-rated health utility index scores (85.1 +/- 9.8 vs 88.0 +/- 11.6, P = .02) and Medical Outcomes Study Short Form Health Survey (SF-12) mental summary scores (46.8 +/- 9.2 vs 51.1 +/- 8.7, P.0001) than women without FI or flatal incontinence. Women with UI had worse SF-12 mental summary scores (48.3 +/- 9.8 vs 51.6 +/- 7.8, P.01) and self-rated health utility index scores (84.1 +/- 12.5 vs 88.7 +/- 10.1, P.01) than women without UI. Women with both FI and UI had the lowest SF-12 mental summary scores (44.5 +/- 9.0).Six months after delivery, women experiencing FI or UI reported negative effects on health-related QOL. FI and UI together have a greater impact than either condition alone.

The purpose of this study was to describe the teaching and practicing of pelvic floor muscle exercise (PFME) before and after delivery.This was a secondary data analysis from a prospective multicenter cohort study, the Childbirth and Pelvic Symptoms study, by the Pelvic Floor Disorders Network. Primiparous women (n = 759) with term singleton delivery were interviewed 6 months after delivery.Sixty-four percent of the women had been taught PFME, most with verbal (76%) and/or written instructions (55%) and a few (10%) during pelvic examination. Women with anal sphincter tears were not more likely to receive instruction or reminders after delivery. More white women (75%) were taught PFME than were Asian women (48%), African American women (36%), or Hispanic women (39%; P.0001). More women with college education (74%) were taught, compared with women without a college education (37%; P.0001). Of those women who were taught, 68% performed PFME after delivery, and 63% were still performing the exercises 6 months after delivery.Results reveal tremendous potential for the improvement of PFME education and targeting at-risk women in the peripartum period.

The purpose of this study was to prospectively assess the cases of patients who had undergone a high uterosacral suspension and anterior repair with anterior compartment placement of porcine dermis graft.Thirty-six patients who underwent transvaginal high uterosacral suspension and cystocele repair with graft augmentation from June 2001 to July 2004 were identified from the University of Alabama at Birmingham Genitourinary Disorders database. Analysis included the pre- and postoperative Pelvic Organ Prolapse Quantification examinations and incontinence impact questionnaire-7/urogenital distress inventory-6.Mean Pelvic Organ Prolapse Quantification Ba improved from +3.3 +/- 2.2 cm to -0.6 +/- 1.7 cm (P.01). Postoperative Ba was prolapse stage II or greater in 50% of subjects. Mean incontinence impact questionnaire-7 scores improved from 36.2 +/- 31.9 to 15.6 +/- 26.2 (P.01), as did mean urogenital distress inventory-6 scores from 58.2 +/- 26.8 to 23.8 +/- 22.6 (P.01).Significant improvements in Pelvic Organ Prolapse Quantification measures, urinary symptoms, and the impact of incontinence were seen after the operation. However, a significant proportion of patients had Pelvic Organ Prolapse Quantification stage II prolapse or greater, which made it unclear whether graft use confers a significant advantage.

Objective The purpose of this study was to better understand the subjective bothersomeness of stress urinary incontinence symptoms and their impact on the quality of life of community-dwelling women. Study design We conducted a mail survey of 605 women in the United States who reported symptoms of stress urinary incontinence. Results More than three fourths of the respondents reported their symptoms to be bothersome, with approximately 29% reporting their symptoms to be moderately to extremely bothersome. The odds of moderate-to-extreme bother decreased with age and increased with symptom severity. Concerns about social embarrassment were evident. Conclusion Stress urinary incontinence symptoms can impose a significant burden on the women who have them. The results reinforce the need for health care professionals to be proactive in questioning and educating patients about this common lower urinary tract symptom.

Objective: This study was conducted to identify obstetric risk factors for anal sphincter tear in primiparous patients, patients with a previous cesarean delivery (VBAC), and patients with a previous vaginal delivery (PVD). Study Design: An obstetrics automated record system was accessed to retrospectively review records of all singleton vaginal deliveries at greater than 36 weeks' gestation (excluding breech and stillbirth) from 1995 through 2000 (n = 10,928). A number of potential risk factors for anal sphincter tear (third- and fourth-degree episiotomy extensions and lacerations) were tested with use of multivariate logistic regression analysis. Results: The risk of anal sphincter tear was significantly increased with primiparity (relative risk [RR] 4.08) and VBAC (RR 5.46) compared with PVD, birth weight greater than 4000 g (RR 2.41), forceps delivery (RR 6.00), vacuum delivery (RR 2.18), shoulder dystocia (RR 3.28), and episiotomy (RR 2.59). Conclusion: Efforts to prevent anal sphincter tear might include reconsideration of modifiable risk factors such as episiotomy, operative vaginal delivery, and VBAC. (Am J Obstet Gynecol 2002;187:1194-8.)

Objective This study estimates the prevalence of fecal incontinence (FI) in overweight and obese women with urinary incontinence and compares dietary intake in women with and without FI. Study Design A total of 336 incontinent and overweight women in the Program to Reduce Incontinence by Diet and Exercise clinical trial were included. FI was defined as monthly or greater loss of mucus, liquid, or solid stool. Dietary intake was quantified using the Block Food Frequency Questionnaire. Results Women had a mean (± SD) age of 53 ± 10 years, body mass index of 36 ± 6 kg/m 2 , and 19% were African American. Prevalence of FI was 16% (n = 55). In multivariable analyses, FI was independently associated with low fiber intake, higher depressive symptoms, and increased urinary tract symptoms (all P Conclusion Overweight and obese women report a high prevalence of monthly FI associated with low dietary fiber intake. Increasing dietary fiber may be a treatment for FI.

The objective of the study was to examine changes in bladder symptoms 1 year after abdominal sacrocolpopexy (ASC) with vs without Burch colposuspension.Women without stress urinary incontinence (SUI) symptoms undergoing ASC were randomized to receive or not receive Burch. One year later, irritative, obstructive, and SUI symptoms were assessed in 305 women using Urogenital Distress Inventory subscales. A composite "stress endpoint" combined SUI symptoms, positive stress test, and retreatment.In all women, the mean irritative score decreased from 19.6 +/- 16.3 (mean +/- SD) to 9.1 +/- 10.6; for obstructive symptoms, from 34.8 +/- 21.0 to 6.3 +/- 10.4 (both P.001). Preoperative bothersome irritative symptoms resolved in 74.6% (126 of 169) and obstructive symptoms in 85.1% (212 of 249), independent of Burch. Fewer women with Burch had urge incontinence (14.5% vs 26.8%, P = .048) and fulfilled the stress endpoint (25.0% vs 40.1%, P = .012).ASC reduced bothersome irritative and obstructive symptoms. Prophylactic Burch reduced stress and urge incontinence.