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Promis score changes in stress urinary incontinence treated with pessary versus retropubic midurethral sling

      Objectives

      Stress urinary incontinence (SUI) is the most common form of urinary incontinence in perimenopausal patients and has negative impacts on quality of life. Patient Reported Outcome Measurement Information System (PROMIS) surveys were used to evaluate the effect of treating SUI with pessary or surgery on depression, social functioning, physical functioning, and sleep disturbance. The objective of this study is to evaluate PROMIS scores before and after intervention in women with SUI. Based on pelvic organ prolapse data, it is hypothesized that quality of life measures would improve compared to baseline in patients managed with surgery versus pessary.

      Materials and Methods

      Subjects with SUI were identified from an office’s pessary patient panel and CPT code 57288. A chart review was conducted looking at demographic data, comorbidities, pessary specific information such as size and type, and procedure information such as length, blood loss, and post-operative healing. These data were combined with PROMIS data which patients filled out at each visit. Subjects were classified as 1) treated with a pessary only, 2) retropubic midurethral sling procedure only, or 3) crossing over from pessary to surgery. Patients were excluded if they did not fill out two or more PROMIS surveys consisting of baseline and follow up. PROMIS data were analyzed using the General Estimating Equation Model and then adjusted for covariates.

      Results

      223 subjects receiving treatment for SUI during the study period were identified. 35 were rejected due to lack of PROMIS data. 95 were characterized as pessary only, 71 were classified as retropubic midurethral sling only, and 22 as crossover. The surgery group had a slightly lower BMI, comorbidity score, and mean age. Baseline scores for depression were lower (indicating fewer symptoms of depression) in the surgery group (45.5) compared to baseline of the pessary group (48.6) and the crossover group (47.7). Unadjusted analysis of PROMIS depression scores showed the greatest improvement in the surgery group (decreased to a nadir of 42.4), while depression worsened in the pessary group (increased to 51.4, with p=0.0047 between all groups). Social scores were higher in the surgery group at baseline and improved after surgery, indicating more satisfaction with social roles. Physical functioning and sleep measures were not different across groups. When adjusting for covariates (BMI, gravidity, parity, and comorbidities), only social scores were different (p=0.0218). BMI had significant effects on social and physical function scores.

      Conclusion

      PROMIS quality of life measures demonstrated an improvement in social function and depression scores in subjects treated with retropubic midurethral sling versus pessary.