title: Psychosocial factors related to the use of InterStim® for the treatment of refractory overactive bladder.
abstract: OBJECTIVE
  Sacral neuromodulation is a well-established treatment of refractory overactive bladder (OAB). Although literature exists on the psychosocial impact of other implanted medical devices, data do not exist for InterStim therapy. We aim to evaluate the relationship between optimism and treatment satisfaction in women undergoing InterStim for refractory OAB and change in OAB symptoms.
  
  
  METHODS
  Adult women undergoing InterStim therapy for refractory OAB completed a series of validated questionnaires before test stimulation assessing optimism, urinary symptom severity, depression, and body image. Questionnaires included the Life Orientation Test-Revised, OAB Questionnaire-Short Form, Major Depression Inventory, and a body image scale. Three months postoperatively, participants repeated the questionnaires to assess urinary symptoms, depression, and body image and completed the OAB Satisfaction with Treatment Questionnaire (OAB-SAT-q). Correlations assessed the relationship between the Life Orientation Test-Revised score and OAB-SAT-q subscale scores, and the OAB questionnaire subscale change scores. Subjects also completed the nonvalidated questions aimed at patients concerns regarding the implanted devices preoperatively and postoperatively.
  
  
  RESULTS
  Twenty-eight women were included. Level of optimism was weakly correlated with subject satisfaction across all OAB-SAT-q subscales (r value of -0.11, -0.21, -0.42, and -0.20 for satisfaction, endorsement, adverse effects, and convenience, respectively). Optimism had a weak correlation with change in OAB symptoms in symptom severity and health-related quality of life subscales. Comparison of preoperative and postoperative questionnaires demonstrated statistically significant improvements in depression, body image, symptom severity, and health-related quality of life. Patients concerns regarding implanted devices changed only marginally.
  
  
  CONCLUSIONS
  The level of optimism did not correlate with satisfaction with InterStim treatment, change in OAB symptoms, or OAB-related quality of life. Health-related quality of life, OAB symptoms, depression, and body image improved after InterStim treatment.
authors.affiliation: From the *Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA; †Department of Obstetrics and Gynecology, Duke University, Durham; and ‡Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC.
authors.forename: Pamela June
authors.initials: PJ
authors.lastname: Levin
authors.forename: Nazema Yusuf
authors.initials: NY
authors.lastname: Siddiqui
authors.forename: Jennifer Marie
authors.initials: JM
authors.lastname: Wu
authors.forename: Cindy Louise
authors.initials: CL
authors.lastname: Amundsen
mesh_terms: D000368:Aged; D001828:Body Image / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000523:psychology / Q000628:therapy*