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Purpose: The study aimed to translate the Urethral Stricture Surgery Patient Reported Outcome Measures (USS-PROM) questionnaire in Dutch. To validate this translated questionnaire, the study evaluates its psychometric properties in a different population, a different environment, and a different health care system. Questions about urinary incontinence and sexual functioning were added., Materials and Methods: Between December 2014 and January 2017, Dutch-speaking adult men scheduled for urethroplasty at Ghent University Hospital were prospectively enrolled in this study. Patients completed the USS-PROM before surgery, 3-6 months after surgery, and 1 year after surgery. Psychometric criteria included content validity, criterion validity, internal consistency, reproducibility, responsiveness, and floor and ceiling effects. (EC/2014/0438)., Results: A total of 100 patients were included, 39 patients completed both the preoperative and the postoperative questionnaire, and 30 patients completed the USS-PROM twice within a short period of time in order to evaluate test-retest reliability. Pearson correlation coefficients showed no statistical significant correlation between lower urinary tract symptoms (LUTS) scores and maximum flow rates. Cronbach's α was 0.81 and 0.89, respectively, for the LUTS score and the summative Male Sexual Health Questionnaire Ejaculatory Dysfunction short form (MSHQ-EjD short form) score. The intraclass correlation coefficients ranged from 0.72 to 0.94. Significant changes were observed in all items except the MSHQ-EjD short form scores. All values exceeded the predefined thresholds., Conclusions: The Dutch version of the USS-PROM has adequate psychometric properties and is a valid instrument to assess patient-reported outcome measures in men undergoing urethroplasty., (© 2017 S. Karger AG, Basel.)

Background: Pelvic floor symptoms are common and are negatively associated with sexual function which, in turn, is an important aspect of quality of life. The majority of older women with pelvic floor symptoms are treated in general practice but evidence from studies in general practice on the sexual functioning of these women is scarce., Aim: This study examined predictors of sexual inactivity in older women with pelvic floor symptoms in general practice and of sexual functioning in those women who are sexually active., Design and Setting: Cross-sectional study in women (aged ≥55 years) from 20 general practices who screened positive on a pelvic floor symptom questionnaire., Method: Logistic and linear regression analyses were used to determine predictors of sexual inactivity and sexual functioning (PISQ-12) by assessing their association with patient characteristics, symptoms (PFDI-20) and degree of prolapse (POP-Q)., Results: A total of 639 women were included (sexually active n = 393, sexually inactive n = 246). Predictors of sexual inactivity were increasing age (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10 to 1.17) and lower education (OR = 2.31; 95% CI = 1.50 to 3.54; Nagelkerke R(2) = 0.208). In sexually active women, sexual functioning was associated with pelvic floor symptom distress (P<0.001) and pelvic floor surgery (P = 0.018; R(2) = 0.138)., Conclusion: In older women with pelvic floor symptoms, increasing age and lower educational level are predictors of sexual inactivity. Many of these older women are sexually active and pelvic floor symptom distress is negatively associated with sexual functioning. These results may encourage GPs to ask about sexual problems in women with pelvic floor symptoms.

Background: Female urinary incontinence is a common condition that has a negative influence on quality of life and generates high costs, but spontaneous help-seeking is limited. In the URINO trial the effects and cost-effectiveness of actively encouraging older women to undergo diagnostics and treatment for urinary incontinence were compared with usual care., Objectives: To describe the design of the URINO trial and to give data on the effect of treatment uptake after screening. In the discussion, the criteria of Wilson and Jungner are applied to discuss whether screening for urinary incontinence is suitable., Methods: In a cluster randomized trial all registered female patients aged ≥55 years received a screening questionnaire. The intervention consisted of actively encouraging women to undergo diagnostics, after which tailored treatment was offered. In the control group care as usual was offered, but uptake of diagnostics and treatment was not encouraged. Results The response rate was 76%. 31% reported urinary incontinence; of these, 47% was willing to participate. All patients in the intervention group underwent diagnostics and treatment uptake was 80%; in the control group this was 2%., Conclusion: To increase treatment uptake, screening must be followed by active encouragement for further diagnostics and treatment. Based on the principles of Wilson and Jungner, female urinary incontinence is a condition suitable for screening. The effect of treatment however needs further evaluation before screening can be recommended. The results of the URINO trial will fill this gap in knowledge., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To study differences in functional status at admission in acutely hospitalized elderly patients with urinary incontinence, a catheter, or without a catheter or incontinence (controls) and to determine whether incontinence or a catheter are independent risk factors for death, institutionalization, or functional decline., Design: Prospective cohort study conducted between 2006 and 2008 with a 12-month follow-up., Setting: Eleven medical wards of 2 university teaching hospitals and 1 teaching hospital in The Netherlands., Participants: Participants included 639 patients who were 65 years and older, acutely hospitalized for more than 48 hours., Measurements: Baseline characteristics, functional status, presence of urinary incontinence or catheter, length of hospital stay, mortality, institutionalization, and functional decline during admission and 3 and 12 months after admission were collected. Regression analyses were done to study a possible relationship between incontinence, catheter use, and adverse outcomes at 3 and 12 months., Results: Of all patients, 20.7% presented with incontinence, 23.3% presented with a catheter, and 56.0% were controls. Patients with a catheter scored worst on all baseline characteristics. A catheter was an independent risk factor for mortality at 3 months (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.10-2.70), for institutionalization at 12 months (OR = 4.03, 95% CI 1.67-9.75), and for functional decline at 3 (OR = 2.17, 95% CI 1.32-3.54) and 12 months (OR = 3.37, 95% CI 1.81-6.25). Incontinence was an independent risk factor for functional decline at 3 months (OR = 1.84, 95% CI 1.11-3.04)., Conclusion: There is an association between presence of a catheter, urinary incontinence, and development of adverse outcomes in hospitalized older patients., (Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: We aim to quantify changes in detrusor function and pressure-flow parameters after radical retropubic prostatectomy (RRP) and to determine the impact of the level of intensity of pelvic floor muscle exercises (PFME) on these changes. We also tried to identify preoperative urodynamic factors, predictive of postoperative continence status., Methods: Sixty-six patients were included in the study. An urodynamic examination was performed before surgery and 26 weeks after catheter removal. All patients were instructed in PFME. However the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME)., Results: In 66 men pre- as well as postoperative urodynamic studies were available for analysis. Overall, Q(max) increased, p(det.Qmax) and the urethral resistance factor URA decreased significantly after surgery. At baseline, detrusor overactivity (DOA) was found in 34% and 5.3% of the men who were still incontinent 6 months postoperatively and those who regained continence, respectively (P = 0.015). Postoperatively, Q(max) was significantly higher (P = 0.04) and URA significantly lower (P = 0.047) in the physiotherapist-guided group. No prognostic standard urodynamic factors for post-RP incontinence (PRPI) were identified., Conclusion: In univariate analysis, preoperative DOA is associated with a higher risk of remaining incontinent after surgery. However, in multivariate analysis, urodynamic parameters predictive of PRPI could not be identified. Therefore, standard preoperative filling cystometry and pressure-flow studies seem to have no role as preoperative predictors of PRPI in patients with localized prostate cancer. More intensive PFME might have a lowering effect on bladder outflow resistance after RRP., (Copyright © 2012 Wiley Periodicals, Inc.)

Aims: We analyzed the impact of radical retropubic prostatectomy (RRP) on the urethral sphincter function as assessed by urethral pressure profilometry (UPP) and its relation to post-radical prostatectomy continence status. Furthermore, we analyzed the effect of intensive pelvic floor muscle exercises (PFME) on the urethral sphincter function., Methods: Sixty-six patients were included in the study. UPP was performed before RRP and 26 weeks after catheter removal. All patients were instructed in PFME, however, the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME)., Results: In 66 patients, pre- as well as postoperative UPP was evaluable. After surgery, the functional profile length and the maximum urethral closure pressure (MUCP) showed a median decrease of 64% and 41%, respectively. For men who had regained continence after 6 months the median MUCP was significantly higher both before and after operation as compared to men who were still incontinent. In multivariate analysis, non-nerve sparing approach was a prognostic factors for a higher relative decrease of the MUCP after RRP. Comparing the PG-PFME group with the F-PFME group there were no significant differences in changes in UPP parameters., Conclusions: A poor preoperative MUCP seems to be an important prognostic factor for persistent incontinence after RRP. Non-nerve sparing approach seems to be an important prognostic factor for impairment of the urethral sphincter function as measured by UPP. More intensive physiotherapy seems to have no additional effect on the postoperative urethral sphincter function as measured by UPP., (Copyright © 2012 Wiley Periodicals, Inc.)

Aims: This study was conducted to try to objectify assessment of pediatric uroflowmetry curves., Materials and Methods: Nine professionals in pediatric incontinence care judged 480 pediatric uroflows. On a 1-5 scale, where 1 = anomalous and 5 = normal, uroflows were assessed on four items: staccato, interrupted, flow time and obstruction. Eighty uroflows were re-evaluated for intra-observer agreement. After staccato and interrupted flow had been defined more sharply, another 100 uroflows were analyzed. Cohen's Kappa test for nominally classified data was applied to assess agreement. Kappa value of <0.20 denoted poor agreement, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 substantial and 0.81-1.0 perfect or almost perfect agreement. A second analysis was done using a 3 point scale, anomalous, intermediate and normal., Results: For interobserver agreement, Kappas were 0.45 for staccato flow, 0.67 for interrupted, 0.59 for flow time, and 0.66 for obstruction. For intra-observer agreement, Kappas were 0.47 for staccato, 0.65 for interrupted, 0.55 for flow time, and 0.65 for obstruction. On a three-point scale, anomalous, intermediate, and normal, interobserver agreement was equal to 0.80 or above. In the second 100 uroflows, the interobserver agreement Kappas were 0.44 for staccato, 0.95 for interrupted, 0.71 for flow time and 0.73 for obstruction., Conclusion: Moderate to substantial agreement on uroflowmetry curves can be reached, except for staccato. Agreement increases if staccato and interrupted flows are defined more sharply. Staccato is defined as three or more peaks and troughs of more than the square root of maximal flow without touching 0, whereas interrupted flow needs at least one 0 passage. In a normal, uninterrupted uroflow, flow time is under 15  sec., (Copyright © 2011 Wiley Periodicals, Inc.)

Purpose: The aim of this study was to identify which comorbidities are more common in patients with urinary incontinence compared with patients without this diagnosis., Design of Study: Case-control study. SETTING/METHODS: The data for this study were obtained from the Second Dutch National Survey of General Practice (DNSGP-2) performed in 2001 and were extracted from the electronic medical records of all patients registered in the participating practices in the year of study (2001). Conditional logistic regression was performed using the PHREG (proportional hazards regression) procedure., Results: Urinary tract infections, constipation, and depression were more prevalent in both men and women with urinary incontinence than in controls. In men, heart failure is more common than among controls, and in women, diabetes mellitus, genitourinary prolapse, and chronic obstructive pulmonary disease (COPD)/asthma are more common than among controls., Conclusion: General practitioners could ask for the presence of urinary incontinence in patients with the above described comorbidities.

This study assessed predictors of long-term adherence to pelvic floor muscle exercise (PFME) therapy including a health education programme among women with urinary incontinence. Sequential multiple regression analyses revealed several significant predictors that predicted 50% of variance in long-term adherence behavior. Short-term adherence significantly predicted long-term adherence. Further, women with frequent weekly wet episodes before and 1 year after therapy were more likely to have high adherence levels 1 year after therapy than women with fewer weekly losses. Thus, women seemed to adapt long-term adherence behavior to their symptoms. Adherence to PFME therapy was very high. The protocol checklist for the PFME therapy developed to standardize treatment among physiotherapists had structured therapy content, which may have optimized adherence behavior in this study. Implementation of this protocol checklist in clinical guidelines is suggested.