title: Predicting who will undergo surgery after physiotherapy for female stress urinary incontinence.
abstract: OBJECTIVE
  To predict who will undergo midurethral sling surgery (surgery) after initial pelvic floor muscle training (physiotherapy) for stress urinary incontinence in women.
  
  
  METHODS
  This was a cohort study including women with moderate to severe stress incontinence who were allocated to the physiotherapy arm from a previously reported multicentre trial comparing initial surgery or initial physiotherapy in treating stress urinary incontinence. Crossover to surgery was allowed.
  
  
  RESULTS
  Data from 198/230 women who were randomized to physiotherapy was available for analysis, of whom 97/198 (49 %) crossed over to surgery. Prognostic factors for undergoing surgery after physiotherapy were age <55 years at baseline (OR 2.87; 95 % CI 1.30-6.32), higher educational level (OR 3.28; 95 % CI 0.80-13.47), severe incontinence at baseline according to the Sandvik index (OR 1.77; 95 % CI 0.95-3.29) and Urogenital Distress Inventory; incontinence domain score (OR 1.03; per point; 95 % CI 1.01-1.65). Furthermore, there was interaction between age <55 years and higher educational level (OR 0.09; 95 % CI 0.02-0.46). Using these variables we constructed a prediction rule to estimate the risk of surgery after initial physiotherapy.
  
  
  CONCLUSIONS
  In women with moderate to severe stress incontinence, individual prediction for surgery after initial physiotherapy is possible, thus enabling shared decision making for the choice between initial conservative or invasive management of stress urinary incontinence.
authors: University Medical Centre Utrecht, Room: F05.121, Heidelberglaan 100, PO Box 85500, 3508, GA, Utrecht, The Netherlands, j.labrie@umcutrecht.nl.
authors: J
authors: J
authors: Labrie
authors: A L M
authors: AL
authors: Lagro-Janssen
authors: K
authors: K
authors: Fischer
authors: L C M
authors: LC
authors: Berghmans
authors: C H
authors: CH
authors: van der Vaart
mesh_terms: D000328:Adult; D000367:Age Factors; D018592:Cross-Over Studies; D003661:Decision Support Techniques; D004522:Educational Status; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D011237:Predictive Value of Tests; D019233:Retreatment; D012307:Risk Factors; D012720:Severity of Illness Index; D053825:Suburethral Slings; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery* / Q000628:therapy