Definition of Success after Surgery for Female Stress Incontinence or Voiding Dysfunction: An Attempt at...

Area of Science:

• Urology
• Gynecology
• Female Pelvic Medicine

Background:

• Current definitions of surgical success for stress urinary incontinence (SUI) and voiding dysfunction (VD) in women lack standardization.
• This heterogeneity complicates the comparison of study outcomes and the evaluation of treatment efficacy.

Purpose of the Study:

• To review outcome measures (OMs) and definitions of success in published literature on SUI and VD surgery in women.
• To provide recommendations for standardized definitions of surgical success in future publications.

Main Methods:

• A comprehensive PubMed search was conducted for English-language, full-text articles on SUI and VD surgery in women published between 2010 and 2015.
• Included studies were randomized trials, prospective studies, and retrospective studies.
• Objective and subjective OMs used to define surgical success were systematically reviewed.

Main Results:

• Ninety-five articles met inclusion criteria for SUI surgery outcomes, with most reporting 12-month follow-up.
• The majority of SUI studies (n=48) used both objective and subjective measures; 24 used subjective OMs alone, and 23 used objective OMs alone.
• Common objective measures for SUI included negative cough stress test (CST) and pad test; subjective success often relied on questionnaires like PGI-I, UDI/UDI-6, and ICIQ-SF.
• Only 11 studies focused on VD surgery OMs, with postvoid residual urine (PVR) measurement and subjective symptom resolution being common success criteria.

Conclusions:

• Significant heterogeneity exists in defining surgical success for SUI and VD in women.
• For SUI, recommended objective measures include CST and a 1-hour pad test; subjective success can be assessed using UDI/UDI-6, IIQ, KHQ, ICIQ-SF, or PGI-I questionnaires.
• For VD, surgical cure should incorporate PVR measurement and self-reported symptom resolution.