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Purpose: Current patient-reported outcomes for female urinary incontinence (UI) are limited by their inability to be tailored. Our objective is to describe the development and field testing of seven item banks designed to measure domains identified as important UI in females (UIf). We also describe the calibration and validation properties of the UIf-item banks, which allow for more efficient computerized adaptive testing (CAT) in the future., Methods: The UIf-measures included 168 items covering seven domains: Stress UI (SUI), overactive bladder (OAB), urinary frequency, physical, social and emotional health impact and adaptation. Items underwent rigorous qualitative development and psychometric testing across two sites. Items were calibrated using item response theory and evaluated for internal consistency, construct validity and responsiveness., Results: A total of 750 women (249 SUI, 249 OAB and 252 mixed UI) participated. Mean age was 55 ± 14 years, and 23 % were Hispanic and 80 % white. In addition to face and content validity, the measures demonstrated good internal consistency (coefficient alpha 0.92-0.98) and unidimensionality. There was evidence for construct validity with moderate-to-strong correlations with the UDI (r's ≥ 0.6) and IIQ (r's = ≥0.6) scales. The measures were responsive to change for SUI treatment (paired t test p < .001, ES range 1.3-2.9; SRM range 1.3-2.5) and OAB treatment (paired t test p < .05 for all domains except social health impact and adaptation, ES range 0.3-1.5, SRM range 0.4-1.0). The measures were responsive based on concurrent changes with the UDI and IIQ (p < 0.05). CAT versions were developed and pilot-tested., Conclusions: The UIf-item banks demonstrate good psychometric characteristics and are a sufficiently valid set of customizable tools for measuring UI symptoms and life impact.

Objective: Recent evidence supports improved outcomes in women who undergo an incontinence procedure at the time of apical prolapse repair compared with apical repair alone. Our primary objective was to describe national trends in concomitant apical repair and incontinence procedures that were performed in the United States from 2001-2009. A secondary objective was to describe complications and length of stay., Study Design: We used the Nationwide Inpatient Sample to collect data on hospital discharges for women who had inpatient apical prolapse surgery from 2001-2009. We included women whose records included the International Classification of Disease-9 Clinical Modification procedure codes for apical procedures with and without incontinence procedures. We examined annual trends in the proportion of concomitant procedures using chi-square testing and multiple logistic regression., Results: Of all apical procedures, the percentage of concomitant incontinence procedures performed increased from 37.9% in 2001 to 47% in 2009 (P = .0002 for trend). In-hospital complications (hemorrhage, bowel obstruction, and/or abscess) were less common with concomitant procedures (6.8% vs 11.7%; P = .02). All geographic regions had increasing trends of concomitant incontinence procedures with no difference among regions (P = .7 for interaction). Both community and academic institutions had increasing trends of concomitant procedures over the study period, with no difference among the types of institutions. Age was not associated with increasing trends in concomitant procedures., Conclusion: The proportion of concomitant apical and incontinence procedures increased in the United States from 2001-2009. Length of stay was slightly longer for the concomitant group, but complications were not increased., (Copyright © 2014 Mosby, Inc. All rights reserved.)

Introduction and Hypothesis: Our goal was to describe patients' personal treatment goals before pelvic floor dysfunction (PFD) surgery and goals achieved and not achieved 12 months after surgery, and to evaluate the association between postoperative symptoms and successful goal achievement., Materials and Methods: We performed a secondary analysis using a de-identified database from a randomized trial comparing native tissue vs. graft-augmented rectocele repair. In their own words, women listed their top four treatment goals and 12 months after surgery whether those goals were or were not achieved. We categorized goals into symptom improvement (defecatory, bulge, incontinence, pain/discomfort) and functioning (physical, social, emotional, sexual). Women completed symptom questionnaires pre- and postoperatively. Goals were described using simple statistics. The association between defecatory, bulge, and incontinence symptoms and goal achievement was described using the chi-square test., Results: Of 160 participants in the database, 125 (78 %) met inclusion criteria. The most common preoperative goals were improvement in bulge (26.7 %), defecation (23.9 %), urinary incontinence (18.1 %), and pain/discomfort (6.2 %). Functioning goal categories included: sexual (7 %), emotional (7 %), physical (6.2 %), and social function (3.3 %). Postoperatively, goal categories in which improvement was achieved were urinary continence (70.5 %), sexual function (58.8 %), bulge reduction (56.9 %), defecation (51.7 %), physical (33.3 %), emotional (29.4 %), and social functioning (25 %). Of the women reporting postoperative defecatory or incontinence symptoms, half reported successful improvement in both goals., Conclusions: Women predominantly reported symptom-related goals, and those goals are most frequently achieved postoperatively. Of women who reported defecatory and incontinence symptoms postoperatively, many still reported successful goal achievement in those areas.

Objective: The purpose of this study was to estimate the effect of insurance status on pelvic floor physical therapy (PFPT) nonparticipation for the treatment of urinary incontinence., Study Design: A cross-sectional study of women referred to PFPT for urinary incontinence between January 2009 and June 2010 was conducted. A telephone questionnaire was administered. Multiple logistic regression was used to identify risk factors for nonparticipation., Results: Thirty-three percent of women with private insurance and 17% with other insurance were PFPT nonparticipants. On multiple logistic regression, women with Medicare were more likely to participate in PFPT (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.72). Risk factors for nonparticipation included insurance noncoverage (OR, 103.85; 95% CI, 6.21-infinity) and a negative perception regarding the benefit of PFPT (OR, 5.07; 95% CI, 2.16-12.49)., Conclusion: Among women who were referred to PFPT for urinary incontinence, insurance noncoverage and negative patient perception of efficacy were risk factors for nonparticipation, although having Medicare was protective. Improving patient education and insurance coverage for PFPT may increase usage., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objective: The aim of this study was to estimate the number of women undergoing ambulatory surgical procedures for female pelvic floor disorders (PFDs) in the United States and to compare age-adjusted ambulatory surgical case rates between 1996 and 2006., Study Design: We analyzed data from the 1996 and 2006 National Survey of Ambulatory Surgery, a federal public access de-identified database. Procedures for PFDs were identified using International Classification of Diseases-9th revision Clinical Modification procedure codes for urinary incontinence, fecal incontinence, and pelvic organ prolapse., Results: The number of women undergoing ambulatory surgical procedures for urinary incontinence increased from 34,968 (95% confidence interval, 25,583-44,353) in 1996 to 105,656 (95% confidence interval, 79,033-132,279) in 2006. The age-adjusted ambulatory surgical case rates for all PFDs increased from 7.91 per 10,000 in 1996 to 12.10 per 10,000 in 2006 (P = .0006)., Conclusion: Ambulatory procedures for urinary incontinence increased between 1996 and 2006, as well as the age-adjusted ambulatory case rate for all PFDs., (Copyright © 2010 Mosby, Inc. All rights reserved.)

Introduction and Hypothesis: The Autonomy Preference Index (API) and Control Preferences Scale (CPS) measure information-seeking and decision-making preferences. Our objective was to validate these scales in women with pelvic floor disorders (PFDs) and identify variables associated with decision-making preferences., Methods: Women seeking care for PFDs completed the API and the CPS. Psychometric properties were determined. Multivariable analyses were used to identify correlates of information-seeking and decision-making preferences., Results: One hundred ten women were recruited. Both scales demonstrated good psychometric properties (intraclass correlation coefficient = 0.5 to 0.7; Cronbach's alpha = 0.8 for the API, and r = -0.3 between the API and CPS). Based on scores, women had strong preferences to be well informed, but were more neutral in their decision-making preferences. In multivariable analyses, higher education levels were associated with a stronger desire for seeking medical information., Conclusions: Women seeking care for PFDs vary in their preferences for participating in treatment decisions.

Objective: We sought to evaluate trends in costs of ambulatory care related to female pelvic floor disorders (PFD) in the United States., Study Design: We used the National Ambulatory Medical Care Survey for national estimates of ambulatory visits in the United States. PFD-related visits were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Visits were assigned an Evaluation and Management code, and costs were estimated using national average Medicare allowances for physician services. We converted costs to 2006 dollars using the physicians' services component of the Consumer Price Index and compared the average annual costs between 1996-1997 and 2005-2006., Results: The average annual cost of ambulatory physician services related to PFDs was $190 million in 1996-1997 and $298 million in 2005-2006 (P=.05). Adjusting for deductibles and copayments, these estimates increased to $262 million in 1996-1997 and $412 million in 2005-2006., Conclusion: The cost of ambulatory care related to female PFDs is significant and is increasing., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Objective: This study was undertaken to modify and validate the Satisfaction with Decision Scale and Decision Regret Scale for women who have undergone surgery for pelvic floor disorders., Study Design: We adapted the Satisfaction with Decision Scale and Decision Regret Scale for women with pelvic floor disorders. Forty-five women who underwent surgery for pelvic floor disorders were enrolled postoperatively and completed the Satisfaction with Decision Scale-Pelvic Floor Disorders and Decision Regret Scale-Pelvic Floor Disorders on 2 occasions, 1 week apart., Results: Face and content validity of the Satisfaction with Decision Scale-Pelvic Floor Disorders and Decision Regret Scale-Pelvic Floor Disorders were confirmed by patient interviews and expert panel. The Satisfaction with Decision Scale-Pelvic Floor Disorders and Decision Regret Scale-Pelvic Floor Disorders were internally consistent (Cronbach's alpha: .95 and .88, respectively) and reproducible (intraclass correlations: 0.82 and 0.84, respectively). Larger improvements between preoperative and postoperative Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7 scores were positively correlated with the Satisfaction with Decision Scale-Pelvic Floor Disorders (r = 0.42 and 0.49, respectively), and negatively correlated with the Decision Regret Scale-Pelvic Floor Disorders (r = -0.60 and -0.63, respectively). The Satisfaction with Decision Scale-Pelvic Floor Disorders and Decision Regret Scale-Pelvic Floor Disorders were negatively correlated with each other (r = -0.55)., Conclusion: The Satisfaction with Decision Scale-Pelvic Floor Disorders and Decision Regret Scale-Pelvic Floor Disorders are reliable and valid decision-making outcome measures for women with pelvic floor disorders.

The article presents a study on the effect of midurethral sling procedure for stress urinary incontinence (SUI) on the leisure physical activity levels and physical functioning of women. After a prospective, observational study of women outpatient, researchers conclude the association between midurethral sling and resulting improvement in urinary incontinence with enhanced physical activity levels and functioning. It also identified risk factors for insufficient postoperative physical activity.