title: Impact of surgery for stress incontinence on the social lives of women.
abstract: OBJECTIVE
  To assess the feasibility of collecting disease-specific and generic data on the impact of surgery on the social lives of women with stress incontinence; to describe the social impact of surgery in a representative group; and to determine the effect of timing on the assessment of outcome.
  
  
  METHODS
  Longitudinal study; questionnaires before and three, six, and twelve months after surgery.
  
  
  METHODS
  Eighteen hospitals in North Thames region.
  
  
  METHODS
  Four hundred and forty-two women undergoing surgery for stress incontinence between January 1993 and June 1994.
  
  
  METHODS
  Post-operative recovery time, stress incontinence symptom impact index, activities of daily living, and cost of protection.
  
  
  RESULTS
  Post-operative recovery was uneventful for most women, but three months after surgery 24% of those in paid employment beforehand were still on sick or unpaid leave. Most women (75%) reported that stress incontinence had less adverse impact on their lives three months after surgery, though 18% reported no change, and 7% felt life was worse. The likelihood of improvement was similar regardless of whether pre-operative urodynamic studies had been conducted. The extent of improvement was dependent on pre-operative severity. Similar findings were obtained six and twelve months after surgery. After an initial slight but nonsignificant deterioration in their ability to carry out activities of daily living, women gained a slight benefit from surgery (proportion with no or only slight limitation rose from 72% to 82%; P=0.0001). The mean cost of protection (pads and towels) fell from 8.59 pound sterling a month before surgery to 2.99 pound sterling a month one year after surgery, by which time 68% of women were not using protection. In contrast, 11% were still spending over 10 pound sterling a month.
  
  
  CONCLUSIONS
  It is possible to collect standard data on the impact of surgery on social functioning and, thus, provide women with better information on likely outcomes. The benefits of pre-operative urodynamic investigations need to be assessed. The stability of the outcome measures over the first post-operative year suggest that outcomes need to be assessed only once and at any time from three to twelve months after the operation.
authors.affiliation: Health Services Research Unit, London School of Hygiene and Tropical Medicine.
authors.forename: N A
authors.initials: NA
authors.lastname: Black
authors.forename: A
authors.initials: A
authors.lastname: Bowling
authors.forename: J M
authors.initials: JM
authors.lastname: Griffiths
authors.forename: C
authors.initials: C
authors.lastname: Pope
authors.forename: P D
authors.initials: PD
authors.lastname: Abel
mesh_terms: D000203:Activities of Daily Living; D001007:Anxiety / Q000209:etiology; D001510:Bed Rest; D017281:Cost of Illness; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016496:Incontinence Pads / Q000191:economics; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D012725:Sexual Behavior; D018582:Sick Leave / Q000706:statistics & numerical data; D014550:Urinary Incontinence, Stress / Q000191:economics / Q000523:psychology / Q000601:surgery*