title: Impact of surgery for stress incontinence on morbidity: cohort study.
abstract: OBJECTIVE
  To describe the impact of surgery for stress incontinence on the severity of symptoms, other mental and physical symptoms, and overall health. To describe the incidence of postoperative complications.
  
  
  METHODS
  Prospective cohort study; questionnaires completed by patients before and 3, 6, and 12 months after surgery. Questionnaires completed by surgeons both before and after surgery.
  
  
  METHODS
  18 hospitals in the North Thames region.
  
  
  METHODS
  442 women treated surgically for stress incontinence between January 1993 and June 1994. 367 women returned the 3 month questionnaire; 364 returned the 6 month questionnaire; and 359 returned the 12 month questionnaire. 49 surgeons provided perioperative information on 285 of the 442 women and postoperative information on 278.
  
  
  METHODS
  Stress incontinence symptom severity index, other urinary symptoms, bowel function, mental health, complications, global measures.
  
  
  RESULTS
  Most women (288; 87%) reported an improvement in the severity of their stress incontinence, though only 92 (28%) were cured (continent). These improvements persisted for at least 12 months. The likelihood of improvement was similar regardless of whether urodynamic pressure studies had been conducted before surgery. Following surgery, women were less likely to suffer from urinary frequency, nocturia, postvoid fullness, dysuria, and urgency. While mental health improved for 194 (71%), a quarter of women reported deterioration. Only 37 (10%) were satisfied with postoperative pain control. A third experienced one or more complications while in hospital, most commonly difficulty urinating. This problem affected 1 in 11 women after discharge. A year after surgery two thirds of women reported feeling better (251; 72%), that the outcome met or exceeded their expectations (230; 66%), and that they would recommend the operation to a friend in a similar situation (239; 68%), and that they would recommend the operation to a friend in a similar situation (239; 68%). Surgeons tended to be more optimistic about the effects of surgery; they were satisfied with the outcome in 176 (85%) cases and would again treat 245 (94%) of the women as they had done previously.
  
  
  CONCLUSIONS
  Although surgery reduces the severity of stress incontinence it is not as effective as current textbooks suggest. Women considering surgery should be provided with more accurate information on the likelihood of an improvement in symptoms and the occurrence of complications, including postoperative pain. Urgency and urge incontinence should not be considered contraindications to surgery. The need for urodynamic assessment before surgery should be reappraised.
authors.affiliation: Health Services Research Unit, London School of Hygiene and Tropical Medicine. n.black@lshtm.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Black
authors.forename: J
authors.initials: J
authors.lastname: Griffiths
authors.forename: C
authors.initials: C
authors.lastname: Pope
authors.forename: A
authors.initials: A
authors.lastname: Bowling
authors.forename: P
authors.initials: P
authors.lastname: Abel
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D017060:Patient Satisfaction; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*