Advertisement

The association of Incontinence Symptom Index scores with urethral function and support

Published:November 03, 2008DOI:https://doi.org/10.1016/j.ajog.2008.07.027

      Objective

      The objective of this study was to establish categories of symptom severity based on Incontinence Symptom Index (ISI) scores and to show how these categories are associated with urethral function and support.

      Study Design

      Women with stress incontinence (n = 97) and asymptomatic controls (n = 98) completed the ISI. Asymptomatic women's scores were between 0 and 6; this range was designated as absent/mild (n = 104). The median score for symptomatic women was 16; scores from 7 to 16 (n = 50) were designated as moderate, and scores of 17 or greater (n = 40) were designated as severe.

      Results

      Urethral function differed in women with mild, moderate, and severe scores: Valsalva leak point pressure (162.3 vs 123.5 vs 101.9 cm H2O; P = .001), cough leak point pressure (202.0 vs 163.0 vs 134.3 cm H2O; P = .001), and maximum urethral closure pressure (69.1 vs 44.1 vs 35.3 cm H2O; P = .001). Loss of urethrovesical support (point Aa: -1.0 vs -0.6 vs -0.5 cm; P = .004) was found in women with moderate and severe symptoms, compared with those with mild symptoms.

      Conclusion

      Categories of symptom severity assessed by the ISI are associated with urethral function and support.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Diokno A.C.
        • Brock B.M.
        • Brown M.B.
        • Herzog A.R.
        Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly.
        J Urol. 1986; 136: 1022-1025
        • Burgio K.L.
        • Matthews K.A.
        • Engel B.T.
        Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women.
        J Urol. 1991; 146: 1255-1259
      1. Wei JT, Dunn RL, Hoag L, Faerber G, Dorr R, McGuire EJ. The Incontinence Symptom Index (ISI): a novel and practical symptom score for the evaluation of urinary incontinence severity, In press.

        • Naughton M.J.
        • Donovan J.
        • Badia X.
        • et al.
        Symptom severity and QOL scales for urinary incontinence.
        Gastroenterology. 2004; 126: S114-S123
        • Shumaker S.A.
        • Wyman J.F.
        • Uebersax J.S.
        • McClish D.
        • Fantl J.A.
        Health-related quality of life measures for women with urinary incontinence: The Incontinence Impact Questionnaire and the Urogenital Distress Inventory.
        Qual Life Res. 1994; 3: 291-306
        • Uebersax J.S.
        • Wyman J.F.
        • Shumaker S.A.
        • McClish D.K.
        • Fantl J.A.
        Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory.
        Neurourol Urodyn. 1995; 14: 131-139
        • Barry M.J.
        • Fowler Jr, F.J.
        • O'Leary M.P.
        • et al.
        The American Urological Association Symptom Index for benign prostatic hyperplasia.
        J Urol. 1992; 148: 1549-1557
        • Ko D.S.
        • Fenster H.N.
        • Chambers K.
        • Sullivan L.D.
        • Jens M.
        • Goldenberg S.L.
        The correlation of multichannel urodynamic pressure-flow studies and American Urological Association Symptom Index in the evaluation of benign prostatic hyperplasia.
        J Urol. 1995; 154: 396-398
        • Barry M.J.
        • Cockett A.T.
        • Holtgrewe H.L.
        • McConnell J.D.
        • Sihelnik S.A.
        • Winfield H.N.
        Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia.
        J Urol. 1993; 150: 351-358
        • Lemack G.E.
        • Zimmern P.E.
        Predictability of urodynamic findings based on the Urogenital Distress Inventory-6 questionnaire.
        Urology. 1999; 54: 461-466
        • DeLancey J.O.
        • Trowbridge E.R.
        • Miller J.M.
        • et al.
        Stress urinary incontinence: relative importance of urethral support and urethral closure pressure.
        J Urol. 2008; 179: 2286-2290
        • Andresen E.M.
        • Malmgren J.A.
        • Carter W.B.
        • Patrick D.L.
        Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale).
        Am J Prev Med. 1994; 10: 77-84
        • Weber A.M.
        • Taylor R.J.
        • Wei J.T.
        • Lemack G.
        • Piedmonte M.R.
        • Walters M.D.
        The cost-effectiveness of preoperative testing (basic office assessment vs. urodynamics) for stress urinary incontinence in women.
        BJU Int. 2002; 89: 356-363
        • FitzGerald M.P.
        • Brubaker L.
        Urinary incontinence symptom scores and urodynamic diagnoses.
        Neurourol Urodyn. 2002; 21: 30-35
        • Barry M.J.
        • Fowler Jr, F.J.
        • O'Leary M.P.
        • Bruskewitz R.C.
        • Holtgrewe H.L.
        • Mebust W.K.
        Correlation of the American Urological Association Symptom Index with self-administered versions of the Madsen-Iversen, Boyarsky and Maine Medical Assessment Program Symptom indexes.
        J Urol. 1992; 148: 1558-1564
        • Scarpero H.M.
        • Fiske J.
        • Xue X.
        • Nitti V.W.
        American Urological Association Symptom Index for lower urinary tract symptoms in women: correlation with degree of bother and impact on quality of life.
        Urology. 2003; 61: 1118-1122
        • Groutz A.
        • Blaivas J.G.
        • Fait G.
        • Sassone A.M.
        • Chaikin D.C.
        • Gordon D.
        The significance of the American Urological Association Symptom Index score in the evaluation of women with bladder outlet obstruction.
        J Urol. 2000; 163: 207-211
        • Chancellor M.B.
        • Rivas D.A.
        American Urological Association Symptom Index for women with voiding symptoms: lack of index specificity for benign prostate hyperplasia.
        J Urol. 1993; 150: 1706-1709
        • Nitti V.W.
        • Kim Y.
        • Combs A.J.
        Correlation of the AUA symptom index with urodynamics in patients with suspected benign prostatic hyperplasia.
        Neurourol Urodyn. 1994; 13: 521-529
        • Sirls L.T.
        • Kirkemo A.K.
        • Jay J.
        Lack of correlation of the American Urological Association Symptom 7 Index with urodynamic bladder outlet obstruction.
        Neurourol Urodyn. 1996; 15: 447-457
        • Tapp K.
        • Connolly A.
        • Visco A.G.
        Evaluation of Aa point and cotton-tipped swab test as predictors of urodynamic stress incontinence.
        Obstet Gynecol. 2005; 105: 115-119
        • Bergman A.
        • Koonings P.P.
        • Ballard C.A.
        Negative Q-tip test as a risk factor for failed incontinence surgery in women.
        J Reprod Med. 1989; 34: 193-197
        • Larrieux J.R.
        • Balgobin S.
        Effect of anatomic urethral length on the correlation between the Q-tip test and descent at point Aa of the POP-Q system.
        Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 273-276
        • Noblett K.
        • Lane F.L.
        • Driskill C.S.
        Does pelvic organ prolapse quantification exam predict urethral mobility in stages 0 and I prolapse?.
        Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16: 268-271
        • Bai S.W.
        • Kang S.H.
        • Kim S.K.
        • Kim J.Y.
        • Park K.H.
        The effect of pelvic organ prolapse on lower urinary tract function.
        Yonsei Med J. 2003; 44: 94-98
        • Cogan S.L.
        • Weber A.M.
        • Hammel J.P.
        Is urethral mobility really being assessed by the pelvic organ prolapse quantification (POP-Q) system?.
        Obstet Gynecol. 2002; 99: 473-476
        • Latini J.M.
        • Zimmerman M.B.
        • Kreder Jr, K.J.
        Association between Valsalva and cough leak point pressures and pelvic organ prolapse quantification in women with stress incontinence.
        J Urol. 2005; 173: 1219-1222
        • Bradley C.S.
        • Nygaard I.E.
        Vaginal wall descensus and pelvic floor symptoms in older women.
        Obstet Gynecol. 2005; 106: 759-766
        • Zyczynski H.M.
        • Lloyd L.K.
        • Kenton K.
        • et al.
        Correlation of Q-tip values and point Aa in stress-incontinent women.
        Obstet Gynecol. 2007; 110: 39-43