DOES NOCTURNAL INCONTINENCE AFFECT THE HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH...
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110 THE JOURNAL OF UROLOGY ® Vol. 179, No. 4, Supplement, Sunday, May 18, 2008 life restrictions and social strains. The period of data collection was 1/2001 to 12/2006. RESULTS: The mean age of UGT cancer pts. was 60±15.3 among urogenital tumor entities were: prostate cancer 45%, renal cell cancer 25%, urothelial cancer 27% and germ cell tumors 3%. The total QSC-R23 scores of both patient groups (UGT cancers: n=196 vs other cancers: n=683) were 1.22 each. In the group of pts. with UGT cancers, two items of the QSC-R23 showed the highest total scores: “having sex less frequently” (score: 2.41) and “being afraid of disease progression” (score: 2.33). The proportion of the highest response categories “strongly/very strongly distressed” within these items were 37% and 32%, respectively. Compared with other cancer pts., in the UGT cancer pts. the vs 2.41) with the largest difference of the mean values. Percentage of response categories: strongly/very strongly distressed) was 34% for UGT cancer pts. and 38% for pts. with other cancers (p=0.25). CONCLUSIONS: This retrospective analysis of unselected male patients with urogenital cancers showed that about one third of these patients belong to a risk group for psychosocial distress. The item “having sex less frequently” showed the highest score with the largest initiated at our institution. Implementation of routine psycho-oncological care in clinical treatment of cancer patients is mandatory, especially in Comprehensive Cancer Centers. Source of Funding: None 311 DOES NOCTURNAL INCONTINENCE AFFECT THE HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER? Rajinikanth Ayyathurai, Anuradha Jayathillake, Cindy T Soloway, Mark S Soloway, Murugesan Manoharan*. Miami, FL. INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (NB) reconstruction is increasingly becoming the choice of urinary diversion (UD) after radical cystectomy (RC). Varying degrees of nocturnal incontinence (NI) has been reported following ileal NB reconstruction. This can be of concern to the patient, potentially affecting the HRQOL. We assessed the impact of NI on the HRQOL using a validated instrument. METHODS: The Functional Assessment of Cancer Therapy - Vanderbilt Cystectomy Index questionnaire (FACT-VCI) was used to assess the HRQOL in patients who underwent orthotopic NB following RC and had follow-up within the last 12 months. The FACT part of the questionnaire contains 27 questions that assess four aspects of HRQOL: Physical, Social, Emotional and Functional health. The VCI contains 17 questions that focused on the functional outcome of RC and UD. In addition the data on incontinence and use of pads were collected. Analyses was done using SPSS software package. RESULTS: 60 patients received the questionnaire. 58% (35) responded. 91% and 9% of respondents are men and women respectively. 9 (26%) patients were fully continent. 27 (77%) patients were continent during the day. 8 (23%) had day and nighttime incontinence. The patient age and HRQOL index are shown in Table higher at 53 than the patients with incontinence 44 (P=0.01). 18 (51%) patients had NI incontinence, but had good daytime continence (DC). On comparing the VCI score of these patients with those who are fully that DC is the primary factor determining the HRQOL. Similarly, overall FACT health score was not statistically different among fully continent patients compared to those with night only incontinence (P=0.147). This shows that the VCI and FACT-QOL status are dictated by DC irrespective of NI. Table 1. Mean HRQOL index Fully Continent (A) Day & night Incontinence (B) Nightly incontinence (C) P Value A vs. C Overall FACT score 94.2 77.8 83.9 0.147 Physical 23.5 17.5 21.4 0.055 Social 24 21.1 21.9 0.668 Emotional 21 20 20.3 0.628 Functional 26.5 19 20.2 0.012 VCI 53.5 38.7 47.1 0.103 Urinary function 32 21.6 27.7 0.080 Bowel function 18.4 14.8 17.0 0.348 Age 61.3 64.8 66.6 0.076 Follow up 34 30 53 0.463 CONCLUSIONS: NI is not uncommon after ileal neobladder Source of Funding: None 312 THE EFFECT OF SURGERY FOR STRESS URINARY INCONTINENCE ON QUALITY OF LIFE IN WOMEN ENROLLED IN A RANDOMIZED CLINICAL TRIAL COMPARING THE BURCH AND SLING PROCEDURES Philippe E Zimmern*, Chiara Ghetti, Charles W Nager, Elizabeth R Mueller, R Edward Varner, Heather J Litman, John W Kusek, Sharon Tennstedt, Stephen R Kraus. Dallas, TX, Pittsburgh, PA, San Diego, CA, Maywood, IL, Birmingham, AL, Watertown, MA, Bethesda, MD, and San Antonio, TX. INTRODUCTION AND OBJECTIVE: To describe changes in women who received either a Burch or autologous sling for stress urinary incontinence (SUI) and identify baseline factors predicting changes in QoL. METHODS: QoL of 655 women enrolled in a nationwide multi-center clinical trial comparing Burch and sling was measured at baseline and 24-months after surgery with the Incontinence Impact no urinary incontinence on 3-day diary, a negative cough and valsalva stress test, no self-reported incontinence symptoms on the MESA Questionnaire and no re-treatment for SUI by 24-month post-surgery. We examined if change in QoL was related to each procedure and to surgical success. A stepwise least-squares regression analysis was used to examine if the following factors affected post-operative QoL: prior UI function as measured by the Prolapse/Urinary Incontinence Sexual RESULTS: Changes in QoL from baseline to 24 months are shown in Table 1. There was no difference in magnitude of change in QoL between the 2 procedures, but greater improvement in surgical successes. Multivariable modeling showed that QoL improvement was most strongly related to decreased symptom bother (p<0.001), followed by decrease in stress or urge symptoms (p<0.001, p=0.001 respectively), decrease in UI severity (p=0.001), prior UI treatment (p=0.002), younger age (p=0.006) and Hispanic ethnicity (p=0.011). Among sexually active women, worsening sexual dysfunction had a negative impact on QoL (<0.001). CONCLUSIONS: Two common SUI procedures have similar predictors of postoperative improvement in QoL are relevant for preoperative patient counseling. Table 1. Baseline IIQ score and change in score at 24 months. All Burch Sling Surgical Success Surgical Failure N Mean (sd) N Mean N Mean (sd) N Mean (sd) N Mean (sd) Baseline 652 171.4 (101.3) 327 173.2 (99.2) 325 169.7 (103.4) 185 166.6 (102.0) 334 174.7 (101.0) Change in score at 24 mo 608 133.1 (109.8) 299 136.1 a (112.1) 309 130.3 a (107.7) 185 160.0 b (103.9) 329 113.6 b (110.9) a p = 0.52 comparing Burch vs. sling b p<0.001 comparing surgical success vs. failure Source of Funding: NIH/NIDDK for UITN.
Transcript of DOES NOCTURNAL INCONTINENCE AFFECT THE HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH...
110 THE JOURNAL OF UROLOGY® Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
life restrictions and social strains. The period of data collection was 1/2001 to 12/2006.
RESULTS: The mean age of UGT cancer pts. was 60±15.3
among urogenital tumor entities were: prostate cancer 45%, renal cell cancer 25%, urothelial cancer 27% and germ cell tumors 3%. The total QSC-R23 scores of both patient groups (UGT cancers: n=196 vs other cancers: n=683) were 1.22 each. In the group of pts. with UGT cancers, two items of the QSC-R23 showed the highest total scores: “having sex less frequently” (score: 2.41) and “being afraid of disease progression” (score: 2.33). The proportion of the highest response categories “strongly/very strongly distressed” within these items were 37% and 32%, respectively. Compared with other cancer pts., in the UGT cancer pts. the
vs 2.41) with the largest difference of the mean values. Percentage of
response categories: strongly/very strongly distressed) was 34% for UGT cancer pts. and 38% for pts. with other cancers (p=0.25).
CONCLUSIONS: This retrospective analysis of unselected male patients with urogenital cancers showed that about one third of these patients belong to a risk group for psychosocial distress. The item “having sex less frequently” showed the highest score with the largest
initiated at our institution. Implementation of routine psycho-oncological care in clinical treatment of cancer patients is mandatory, especially in Comprehensive Cancer Centers.
Source of Funding: None
311DOES NOCTURNAL INCONTINENCE AFFECT THE HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER?Rajinikanth Ayyathurai, Anuradha Jayathillake, Cindy T Soloway, Mark S Soloway, Murugesan Manoharan*. Miami, FL.
INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (NB) reconstruction is increasingly becoming the choice of urinary diversion (UD) after radical cystectomy (RC). Varying degrees of nocturnal incontinence (NI) has been reported following ileal NB reconstruction. This can be of concern to the patient, potentially affecting the HRQOL. We assessed the impact of NI on the HRQOL using a validated instrument.
METHODS: The Functional Assessment of Cancer Therapy - Vanderbilt Cystectomy Index questionnaire (FACT-VCI) was used to assess the HRQOL in patients who underwent orthotopic NB following RC and had follow-up within the last 12 months. The FACT part of the questionnaire contains 27 questions that assess four aspects of HRQOL:Physical, Social, Emotional and Functional health. The VCI contains 17 questions that focused on the functional outcome of RC and UD.In addition the data on incontinence and use of pads were collected.
Analyses was done using SPSS software package. RESULTS: 60 patients received the questionnaire. 58%
(35) responded. 91% and 9% of respondents are men and women respectively. 9 (26%) patients were fully continent. 27 (77%) patients were continent during the day. 8 (23%) had day and nighttime incontinence. The patient age and HRQOL index are shown in Table
higher at 53 than the patients with incontinence 44 (P=0.01). 18 (51%) patients had NI incontinence, but had good daytime continence (DC). On comparing the VCI score of these patients with those who are fully
that DC is the primary factor determining the HRQOL. Similarly, overall FACT health score was not statistically different among fully continent patients compared to those with night only incontinence (P=0.147). This shows that the VCI and FACT-QOL status are dictated by DC irrespective of NI. Table 1.
Mean HRQOL index
FullyContinent (A)
Day & nightIncontinence (B)
Nightly incontinence (C)
P ValueA vs. C
Overall FACT score 94.2 77.8 83.9 0.147Physical 23.5 17.5 21.4 0.055Social 24 21.1 21.9 0.668Emotional 21 20 20.3 0.628Functional 26.5 19 20.2 0.012VCI 53.5 38.7 47.1 0.103Urinary function 32 21.6 27.7 0.080Bowel function 18.4 14.8 17.0 0.348Age 61.3 64.8 66.6 0.076Follow up 34 30 53 0.463
CONCLUSIONS: NI is not uncommon after ileal neobladder
Source of Funding: None
312THE EFFECT OF SURGERY FOR STRESS URINARY INCONTINENCE ON QUALITY OF LIFE IN WOMEN ENROLLED IN A RANDOMIZED CLINICAL TRIAL COMPARING THE BURCH AND SLING PROCEDURESPhilippe E Zimmern*, Chiara Ghetti, Charles W Nager, Elizabeth R Mueller, R Edward Varner, Heather J Litman, John W Kusek, Sharon Tennstedt, Stephen R Kraus. Dallas, TX, Pittsburgh, PA, San Diego, CA, Maywood, IL, Birmingham, AL, Watertown, MA, Bethesda, MD, and San Antonio, TX.
INTRODUCTION AND OBJECTIVE: To describe changes
in women who received either a Burch or autologous sling for stress urinary incontinence (SUI) and identify baseline factors predicting changes in QoL.
METHODS: QoL of 655 women enrolled in a nationwide multi-center clinical trial comparing Burch and sling was measured at baseline and 24-months after surgery with the Incontinence Impact
no urinary incontinence on 3-day diary, a negative cough and valsalva stress test, no self-reported incontinence symptoms on the MESAQuestionnaire and no re-treatment for SUI by 24-month post-surgery. We examined if change in QoL was related to each procedure and to surgical success. A stepwise least-squares regression analysis was used to examine if the following factors affected post-operative QoL: prior UI
function as measured by the Prolapse/Urinary Incontinence Sexual
RESULTS: Changes in QoL from baseline to 24 months are shown in Table 1. There was no difference in magnitude of change in QoL between the 2 procedures, but greater improvement in surgical successes. Multivariable modeling showed that QoL improvement was most strongly related to decreased symptom bother (p<0.001), followed by decrease in stress or urge symptoms (p<0.001, p=0.001 respectively), decrease in UI severity (p=0.001), prior UI treatment (p=0.002), younger age (p=0.006) and Hispanic ethnicity (p=0.011). Among sexually active women, worsening sexual dysfunction had a negative impact on QoL(<0.001).
CONCLUSIONS: Two common SUI procedures have similar
predictors of postoperative improvement in QoL are relevant for preoperative patient counseling. Table 1. Baseline IIQ score and change in score at 24 months.
All Burch Sling SurgicalSuccess
SurgicalFailure
N Mean(sd) N Mean N Mean
(sd) N Mean(sd) N Mean
(sd)Baseline 652 171.4
(101.3) 327 173.2(99.2) 325 169.7
(103.4) 185 166.6(102.0) 334 174.7
(101.0)Change in score at 24 mo
608 133.1(109.8) 299 136.1a
(112.1) 309 130.3a
(107.7) 185 160.0b
(103.9) 329 113.6b
(110.9)
a p = 0.52 comparing Burch vs. sling b p<0.001 comparing surgical success vs. failure
Source of Funding: NIH/NIDDK for UITN.
