title: Pelvic floor symptoms improve similarly after pessary and behavioral treatment for stress incontinence.
abstract: OBJECTIVE
  The objective of this study was to determine if differences exist in pelvic symptom distress and impact on women randomized to pessary versus behavioral therapy for treatment of stress urinary incontinence (SUI).
  
  
  METHODS
  Change in symptom and condition-specific health-related quality-of-life (HRQOL) measures were compared between pessary and behavioral groups 3 months after randomization in the Ambulatory Treatments for Leakage Associated With Stress Incontinence trial. Four hundred forty-six women with symptoms of SUI were randomized to continence pessary, behavioral therapy (pelvic floor muscle training and continence strategies) or combination therapy. Validated measures utilized included urinary, prolapse, and colorectal scales of the Pelvic Floor Distress Inventory; urinary, prolapse, and colorectal scales of the Pelvic Floor Impact Questionnaire; and Stress and Urge scales of the Questionnaire for Urinary Incontinence Diagnosis. Student t test and analysis of variance were used to compare scores within and between groups.
  
  
  RESULTS
  Mean age of participants was 49.8 (SD, 11.9) years; 84% were white, and 10% were African American. One hundred forty-nine were randomized to pessary, and 146 to behavioral therapy. Baseline symptoms and HRQOL scores were significantly reduced within treatment arms at 3 months after randomization, but there was no statistically significant difference between groups.
  
  
  CONCLUSIONS
  There was no difference in pelvic floor symptom bother and HRQOL between the pessary and behavioral therapy arms in women undergoing conservative treatment for SUI. Individualized preference issues should be considered in the approach to the nonsurgical treatment of SUI.
authors.affiliation: Departments of Obstetrics & Gynecology and Urology, Loyola University Chicago, IL, USA. kkenton@lumc.edu
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.forename: Matthew
authors.initials: M
authors.lastname: Barber
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hsu
authors.forename: David
authors.initials: D
authors.lastname: Rahn
authors.forename: Emily
authors.initials: E
authors.lastname: Whitcomb
authors.forename: Cindy
authors.initials: C
authors.lastname: Amundsen
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Bradley
authors.forename: Halina
authors.initials: H
authors.lastname: Zyczynski
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017773:Pelvic Floor / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000503:physiopathology*; D010570:Pessaries / Q000706:statistics & numerical data*; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*