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PubMed1997

Pelvic muscle exercise/biofeedback for urinary incontinence after prostatectomy: an education program.

BACKGROUND: This study tested the effectiveness of pelvic muscle exercise (PME) with biofeedback in reducing the length of time urinary incontinence (UI) was experienced following a radical prostatectomy for localized prostate cancer. METHODS: Fifty-three men were randomly assigned to an education intervention group or a control group. The education group received instruction in PME/biofeedback and were given a PME protocol to perform three times per week for 12 weeks. The control group did not receive instruction in PME technique. Both groups recorded urine losses in three-day bladder diaries, and 24-hour pad tests were done in weeks 2, 5, 9, and 12 after surgery. Study variables included: 1) length of time urine loss was experienced; 2) episodes and frequency of urine loss; and 3) ounces of urine lost and number of pads used. RESULTS: The PME/biofeedback group regained continence at a mean of 51 days; the non-PME group at 56 days. Although the PME group demonstrated reductions in episodes, frequency, ounces of urine lost by UI, and pad usage, they were not statistically significant. CONCLUSIONS: After prostatectomy, men experience UI for periods of one to 80+ days. The use of biofeedback enhances learning PME and skill performance. Bladder diaries and behavioral management techniques (PME) need to be further studied as appropriate treatment methods to assist men in managing UI after cancer surgery.

Aged↗
PubMed2003

Tolterodine is equally effective in patients with mixed incontinence and those with urge incontinence alone.

OBJECTIVE: To examine the efficacy of tolterodine, an antimuscarinic agent with a bladder-selective profile, in patients with mixed incontinence (MI, stress and urge) compared with patients with urge incontinence (UI) alone. PATIENTS AND METHODS: The study included 239 patients with MI (urge predominating) and 755 with urge incontinence alone from a single-blind, multicentre trial of 1380 patients (80% female) with an overactive bladder. Those completing the trial were analysed 'per-protocol'. After a 7-day washout and a 3-day run-in to collect baseline information, patients were treated with tolterodine twice daily for 16 weeks. The two groups were compared for incontinence episodes/24 h, voiding frequency, nocturia episodes and pad usage after 16 weeks of treatment. RESULTS: After 16 weeks the median changes from baseline for all voiding variables were statistically significant for the MI and the UI groups (P < 0.001), with no apparent significant between-group differences. The median percentage reduction in incontinence episodes from baseline was 67% for the MI and 75% for the UI groups (P = 0.39). 'Dry' rates for the MI and UI groups at the end of the study were 39% (66/171) and 44% (243/552), respectively, whilst 24% of patients in each group (MI 40/170; UI 130/551) achieved a voiding pattern of < 8 voids/24 h. 'Cure' rates for nocturia and the reduction in the number of patients not using pads used were also similar between the groups. CONCLUSION: Tolterodine is as effective in reducing leakage and other symptoms of an overactive bladder in patients with MI as it is in patients with UI alone.

Adult↗
PubMed2001

Recent clinical studies of new pharmacologic agents and their efficacy in the treatment of incontinence.

Two agents for the control of overactive bladder-tolterodine (TOL) and extended-release oxybutynin (Oxy-XL)-have been evaluated in a number of studies for their efficacy in urge incontinence. Studies have demonstrated that TOL achieved a 20% reduction in the frequency of voiding and a 45% reduction in urge incontinent episodes. Efficacy was comparable between TOL and immediate-release oxybutinin (Oxy-IR), the standard anticholinergic comparator. There is a delay of some weeks in achieving relief with TOL, but thereafter there is a continued decrease in the total number of both micturitions and incontinent episodes in 24 hours. Trials demonstrated that there were no safety concerns at all with TOL. In particular, there was a lower incidence of dry mouth with TOL than with Oxy-IR. Dose-ranging studies established that TOL produced the lowest incidence of side effects while maintaining efficacy. In a long-term, community-use study of Oxy-XL, there was a very low incidence of central nervous system side effects, including mental acuity and memory. Among elderly nursing home patients, Oxy-XL achieved a 90% reduction in weekly urge incontinence episodes and an 86% decrease in pad use. Oxy-XL was shown to cause a significantly lower reduction in salivary output than Oxy-IR and TOL. In a recent head-to-head comparison study, there were significant differences found between Oxy-XL and TOL. Other studies have shown that the administration of Oxy-XL results in a significantly lower production of the metabolites responsible for anticholinergic side effect, particularly dry mouth, than with the standard release form, owing largely to the elimination of a first-pass effect. A long-acting form of TOL resulted in a 53% reduction in incontinent episodes. Both these anticholinergic agents have been shown to have excellent efficacy and tolerability. But the future of OAB therapy lies in targeting other mechanisms responsible for incontinence.

Journal Article↗
PubMed1997

Initial experience with the modified vaginal wall sling in the treatment of female stress urinary incontinence.

From March 1995 to March 1996 24 women aged 29-73 years with stress urinary incontinence underwent a modified vaginal wall sling procedure following videourodynamic evaluation. Of these 24, 2 had stress urinary loss due to urethral hypermobility (UH), 3 had intrinsic sphincter deficiency (ISD) and 19 had both UH and ISD. Thirteen (54%) had preoperative urge incontinence, 13 (54%) had associated pelvic floor weakness, including cystocele, and 12 (50%) had had previous pelvic surgery and bladder neck suspension. Twenty-two patients were evaluable for a mean follow-up of 14 months (range 9-21 months). Stress urinary incontinence was resolved in all patients (100%). Of the patients with preoperative urge symptoms, 58% reported resolution but in 42% the urge symptoms remained unresolved. One new patient developed urge and occasional urge incontinence. Out of 22 patients 20 (90.9%) are totally continent; 2 (9.1%) are incontinent and both have documented detrusor instability and occasionally wear pads. The vaginal wall sling is an ideal procedure for the treatment of the various forms of stress urinary incontinence in women. In our series the early results indicate excellent patient acceptability and continence. Long-term follow-up will determine the durability of the procedure.

Adult↗
PubMed1993

Role of the seton in the management of anorectal fistulas.

PURPOSE: To identify the incidence of major fecal incontinence and recurrence after staged fistulotomy using a seton. METHODS: A five-year retrospective chart review of 116 patients (70 males and 46 females) ranging in age from 18 to 81 years (mean, 42 years), in whom setons were placed as part of a surgical procedure for anorectal fistulas, was carried out. Follow-up ranged from 2 to 61 months (mean, 23 months). RESULTS: Setons were employed to identify and promote fibrosis around a complex anorectal fistula as part of a staged fistulotomy in 65 patients (56 percent). Other indications for seton placement included 24 women with anteriorly situated high transsphincteric fistulas (21 percent) and three patients with massive anorectal sepsis (floating, freestanding anus) (2.5 percent). In addition, setons were used to preclude premature skin closure and promote controlled long-term fistula drainage in 21 patients with severe anorectal Crohn's disease (18 percent) and in three patients with AIDS (2.5 percent). Major fecal incontinence (requiring the use of a perineal pad) occurred in five patients (5 percent), and recurrent fistulas were noted in three (3 percent). CONCLUSIONS: Staged fistulotomy using a seton is a safe and effective method of treating high or complicated anorectal fistulas.

Adolescent↗
PubMed1996

Collagen injection for intrinsic sphincteric deficiency in men.

PURPOSE: We evaluated the efficacy of collagen injections in the treatment of male urinary incontinence due to intrinsic sphincteric deficiency. MATERIALS AND METHODS: A total of 88 men (mean age 68 years) with mild to severe intrinsic sphincter deficiency underwent a mean of 3.5 transurethral injections of collagen (mean total volume injected 25 ml.). Patients were subdivided into 2 groups based on use of more than 3 or 3 or fewer pads per day. Patient age, pad use before treatment, duration of leakage, number of injections, volume of collagen used and etiology of incontinence were compared for the 2 groups. RESULTS: Of the patients 42 became nearly completely dry, 19 had substantial improvement but still required 1 to 3 pads per day, 14 consistently used fewer pads but still more than 3 per day and 13 showed no improvement. Most injections were performed with the patient under local anesthesia and no significant morbidity occurred. CONCLUSIONS: In select patients collagen injections appear to be effective, easy to deliver and safe. Pretreatment incontinence severity, concomitant detrusor abnormalities and etiology of intrinsic sphincteric deficiency other than radical retropubic prostatectomy were associated with a worse response to collagen therapy.

Aged↗
PubMed2004

Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence.

OBJECTIVE: To evaluate the long-term cure rates and late complication rates after treatment of female urinary stress incontinence with the minimally invasive tension-free vaginal tape operation. METHODS: Prospective observational, 3-center cohort study originally of 90 women requiring surgical treatment for primary urinary stress incontinence. Assessment variables included a 24-hour pad weighing test, a stress test, visual analog scale for assessing the degree of bother, and a questionnaire assessing the subjective perception of the women on their continence status. RESULTS: The follow-up time was a mean of 91 months (range 78-100 months). Both objective and subjective cure rates were 81.3% for the 80 women available for follow-up. Asymptomatic pelvic organ prolapse was found in 7.8%, de novo urge symptoms in 6.3%, and recurrent urinary tract infection in 7.5% of the women. No other long-term adverse effects of the procedure were detected. CONCLUSION: The tension-free vaginal tape procedure for treatment of female urinary stress incontinence is effective over a period of 7 years.

Adult↗
PubMed1995

Pelvic-floor rehabilitation, Part 2: Pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study.

BACKGROUND AND PURPOSE: This descriptive cohort study investigated a physical therapy program of pelvic-floor neuromuscular electrostimulation (NMES) combined with exercises, with the aim of developing a simple, inexpensive, and conservative treatment for postpartum genuine stress incontinence (GSI). SUBJECTS: Eight female subjects with urodynamically established GSI persisting more than 3 months after delivery participated in the study. The subjects ranged in age from 24 to 37 years (X = 32, SD = 4.2). METHODS: This was a descriptive multiple-subject cohort study. Each subject received a total of nine treatment sessions during 3 consecutive weeks, consisting of two 15-minute sessions of NMES followed by a 15-minute pelvic-floor muscle exercise program. Patients also practiced daily pelvic-floor exercises during the 3-week treatment period. The treatment intervention was measured using three separate variables. Maximum muscle contractions (pretraining, during training, and post-training) were measured indirectly as pressure, using perineometry. Urine loss pretraining and posttraining was measured by means of a Pad test. Self-reported frequency of incontinence was recorded daily throughout the period of the study, using a diary. Data were analyzed using a one-way repeated-measures analysis of variance (ANOVA), a Wilcoxon signed-ranks test, and a Friedman two-way ANOVA by ranks. RESULTS: The results indicated that maximum pressure generated by pelvic-floor contractions was greater and both the quantity of urine loss and the frequency of incontinence were lower following the implementation of the physical therapy program. Five subjects became continent, and three others improved. A follow-up survey 1 year later confirmed the consistency of these results. CONCLUSION AND DISCUSSION: The results suggest that the proposed physical therapy program may influence postpartum GSI. Further studies are needed to validate this simple, inexpensive, and conservative physical therapy protocol. [Dumoulin C, Seaborne DE, Quirion-DeGirardi C, Sullivan SJ. Pelvic-floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women--a cohort study.

Adult↗
PubMed1995

Functional assessment of ileal pouch-anal anastomotic techniques.

BACKGROUND: Recent advances in ileal pouch-anal anastomotic (IPAA) technique include the substitution of a double stapled anastomosis for a mucosectomy and hand-sewn pouch-anal anastomosis, and the use of staples to construct a "J" shaped pouch rather than a hand-sewn "S" pouch in most cases. METHOD: To determine the impact these technical changes have had on pouch function, 235 IPAA patients with 15 to 155 months of follow-up (mean 70 months) were interviewed by telephone concerning pouch function and quality of life. Categorical responses were then evaluated by contingency table analysis to detect differences between mucosectomy (n = 157) and nonmucosectomy (n = 80) groups, and between J pouch (n = 50), S pouch with mucosectomy (n = 137), and S pouch nonmucosectomy (n = 30) subgroups. An index encompassing nine functional measures was used to quantify the overall impact of technique changes (optimal score 100). RESULTS: Stool frequency for mucosectomy patients was 7.2 movements/24 hours, compared to 7.1 for nonmucosectomy patients. Elimination of a mucosectomy dramatically reduced nocturnal major incontinence (P < 0.001), nocturnal minor incontinence (P < 0.001), daytime minor incontinence (P = 0.03), and day-time pad use (P = 0.002). Nonmucosectomy patients had a better functional index score than had patients with an S pouch, even when only data from nonmucosectomy patients were analyzed (J = 95.5, S = 91.8, P = 0.009). CONCLUSIONS: Avoidance of a mucosectomy in the performance of an ileal pouch-anal anastomosis does not influence stool frequency but does significantly improve fecal continence and introduces no detectable morbidity associated with the retained rectal mucosa.

Adult↗
PubMed2006

Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review.

PURPOSE: We systematically reviewed the evidence on the efficacy and safety of sacral nerve stimulation (SNS) for severe urge incontinence. MATERIALS AND METHODS: A systematic review was performed of primary studies of SNS for urge incontinence published in English between 1966 and May 2003, and identified in major electronic databases. Two reviewers independently selected studies, assessed their methodological quality and extracted data. RESULTS: Four randomized controlled trials and 30 case series were identified. Evidence from the randomized controlled trials, involving approximately 120 patients, showed that about 80% achieved continence or greater than 50% improvement in their main incontinence symptoms after SNS compared with about 3% of controls receiving conservative treatments while waiting for an implant. While case series were larger, they were methodologically less reliable. However, they showed similar results with 67% of patients becoming dry or achieving a greater than 50% improvement in symptoms after implantation. Incontinence episodes, leakage severity, voiding frequency and pad use were significantly lower after implantation. Benefits were reported to persist 3 to 5 years after implantation. Adverse events were documented in 27 studies. Overall the reoperation rate in implanted cases was 33%. The most common reason for surgical revision was relocation of the generator because of pain and infection. Common complications were pain at the implant or lead site in 25% of patients, lead related problems such as lead migration in 16%, replacement and repositioning of the implanted pulse generator in 15%, wound problems in 7%, adverse effects on bowel function in 6%, infection in 5% and generator problems in 5%. Permanent removal of the electrodes was reported in 9% of patients. Technical changes with time have been associated with decreased complication rates. CONCLUSIONS: There is evidence indicating that SNS is effective for decreasing symptoms in patients with urge incontinence. Adverse events occurred in about half of the implanted cases and surgical revision was performed in 33%. No major irreversible complications were reported in the studies reviewed. Further research is required on the long-term effects of and quality of life in patients with SNS.

Adult↗
PubMedDate not supplied

Vaginal diaphragm rings in the treatment of stress urinary incontinence.

To assess the effectiveness of wearing vaginal diaphragm rings in the treatment of stress urinary incontinence, 10 women with genuine stress incontinence were studied. Patients underwent urodynamic evaluation and perineal pad testing before and after fitted diaphragm rings were in place. Patients kept symptom diaries for 1 week without the ring and then for 1 week with the ring. They also gave an overall subjective evaluation of their experience. Urodynamic findings were essentially unchanged by wearing diaphragm rings. Trends toward improvement were observed in the results of pad tests and symptom diaries. Four of the 10 women experienced clinically significant improvement in amount of urine lost during pad tests, number of leaks per week, and overall assessment of response. Vaginal diaphragm rings may be an effective treatment for some women with stress urinary incontinence.

Adult↗
PubMed1987

Pseudoincontinence secondary to unopposed estrogen replacement in the surgically castrate premenopausal female.

Over a four-year period, approximately 200 patients were evaluated for incontinence at the Urogynecology Clinic of the University of Minnesota Hospitals. Seven women between the ages of 26-56 complained of incontinence beginning shortly after hysterectomy-oophorectomy for benign disease. Each gave a history of continuous leakage of urine per vagina. Urodynamics, provocative testing, and home pad tests with urinary dye all failed to prove incontinence. A common historic feature was replacement therapy with unopposed conjugated estrogen. Addition of a progestational agent to the estrogen replacement regimen eliminated the fluid loss per vagina in six of the seven women and improved it in the remaining patient. Unnecessary surgery and evaluation might have been prevented had this condition been recognized earlier.

Adult↗
PubMed2005

Paula method of circular muscle exercises for urinary stress incontinence--a clinical trial.

The aim of this study was to determine the efficacy of the Paula method of circular muscle training in the management of stress incontinence (SI). The theory behind this method states that activity of distant sphincters affects other muscles. In a pilot study, 59 women, mainly hospital employees, were randomly assigned to participate in exercises according to the Paula method or pelvic floor training. Efficacy was measured by reports of incontinence, quality of life (I-QOL), pad test, and pelvic floor muscle strength (assessed by perineometer and digital examination). Both the Paula exercises and pelvic floor training produced significant changes in urinary leakage compared to baseline as measured by the pad test [mean decrease of 5.4 g (p=0.002) and 9.5 g (p=0.003), respectively]. Women randomized to the Paula method reported improvement in I-QOL scores. The Paula method was found to be efficacious for SI in a population of Israeli women. Larger community-based studies will be required to confirm these results and enable evaluation of between-group differences.

Adult↗
PubMed2004

Bulbourethral composite suspension:: a new operative technique for post-prostatectomy incontinence.

PURPOSE: A new bulbourethral sling procedure is proposed for patients with post-radical prostatectomy incontinence. MATERIAL AND METHODS: Bulbourethral composite suspension was performed in 16 consecutive patients, of whom 6 (38%) had severe stress incontinence and depended on a condom urinal catheter. Urinary stress incontinence was assessed preoperatively by a modified pad test, urethrocystoscopy and urodynamic evaluation. The procedure was performed with a longitudinal perineal and a transverse suprapubic incision with the patient under regional anesthesia. We placed a porcine dermis for urethral protection and a polypropylene retropubic sling, which was tied suprapubically with the patient coughing and during retrograde urethral closure pressure monitoring at 60 cm H2O. RESULTS: Preoperative evaluation excluded detrusor instability and urethral stricture. The polypropylene band was placed without neurogenic or vascular complications. All patients had primary wound healing. Patients reported only minimal postoperative pain. Clinical followup was performed a median of 14 months postoperatively (range 6 to 32). Of the 16 patients 11 (69%) were completely dry and 1 (6%) reported improved continence, while 4 (25%) had no benefit, including 2 who underwent an artificial sphincter procedure. Preoperative mean daily pad use decreased from 7 (range 2 to 12) to 1 (range 0 to 10) postoperatively (p = 0.0004) and postoperative quality of life improved significantly (p <0.0001). CONCLUSIONS: Bulbourethral composite suspension is a new, efficient operative sling technique in patients with severe post-prostatectomy stress urinary continence. Because morbidity and complications are low, this new technique may become an alternative to artificial urinary sphincter implantation. Long-term observation of urethral and detrusor function is necessary to elucidate the specific contribution of bulbourethral composite suspension in restoring urinary continence after radical prostatectomy.

Aged↗
PubMed1997

Preliminary experience with a urinary control device in the management of women with genuine stress incontinence.

OBJECTIVE: To evaluate the efficacy and acceptability of the FemAssist urinary control device (Insight Medical UK Ltd). PATIENTS AND METHODS: Twenty-seven women with cystometrically confirmed genuine stress incontinence performed a perineal 1 h pad-test; the pad test was then repeated with the FemAssist device in place and the difference in pad weights compared with and without the device in place. Patients were given 100 mm visual analogue scales (VAS) to measure discomfort, acceptability and embarrassment associated with using the device. RESULTS: The median (range) loss with and without the FemAssist device was 4.9 (0-65) mL and 21 (1-94), respectively (P < 0.01); 20 patients were less wet when using the device. The median (range) VAS scores were; discomfort 35 (4-93), embarrassment 11 (0-75), and acceptability 65 (3-100). Discomfort was greater among the women with a greater loss. The acceptability correlated negatively with discomfort (r = -0.53) and negatively with embarrassment (r = -0.39); 15 patients (56%) reported that they would use the device in the long-term. CONCLUSION: The FemAssist device produced a significant reduction in urine loss. The magnitude of benefit could not be predicted for an individual and the device was ineffective in some women. The use of the device was influenced by discomfort and associated embarrassment. The device has a role in the management of stress incontinence but patients must be assessed individually for suitability.

Adult↗
PubMed2003

Severe depression determines quality of life in urinary incontinent women.

AIMS: The purpose of this study was to assess depression and anxiety in urinary incontinent women and to investigate factors influencing their self-perception of urinary incontinence severity. METHODS: In this prospective study, 82 incontinent women estimated the severity of urinary incontinence using a visual analogue scale and completed a validated quality of life instrument: urinary incontinence severity score. Psychiatrists evaluated depression and anxiety using a structured interview of Hamilton Depression and Hamilton Anxiety Scales. Patients were classified on the basis of history and urodynamic evaluation into two diagnostic groups: stress urinary incontinence (n = 57) and idiopatic urge incontinence with or without stress incontinence (n = 25). RESULTS: Major depression occurred in 44.0% of women with idiopatic urge (+/- stress) incontinence and in 17.5% women with stress incontinence (odds ratio (OR 3.69), 95% confidence interval (95% CI 1.30-10.49)). Twenty two patients had severe incontinence defined as Urinary Incontinence Severity Score > or =14 points (upper quartile) and 23 patients defined as visual analogue scale > or =9 (upper quartile). In logistic regression analysis, major depression (OR 5.57; 95% CI 1.19-26.11), urge incontinence diagnosis (OR 23.13; 95% CI 1.90-282.11), parity (OR 2.33; 95% CI 1.16-4.60) and high Urgency Score (OR 1.94; 95% CI 1.32-2.85) predicted Urinary Incontinence Severity Score above the upper quartile. Only the pad-test (OR 1.01; 95% CI 1.00-1.02) predicted visual analogue scale above upper quartile. CONCLUSIONS: Major depression correlates with reduced incontinence specific quality of life. This data also suggests an association between depression and idiopatic urge incontinence.

Adult↗
PubMed2006

Adaptation to Spanish language and validation of the fecal incontinence quality of life scale.

PURPOSE: The aim of this study was to perform a psychometric evaluation of the Fecal Incontinence Quality of Life Scale in the Spanish language. METHODS: Eleven hospitals in Spain participated in the study, which included 118 patients with active fecal incontinence. All the patients filled out a questionnaire on the severity of their incontinence, a general questionnaire of health (Medical Outcomes Survey Short Form), and a Spanish translation of the Fecal Incontinence Quality of Life Scale (Cuestionario de Calidad de Vida de Incontinencia Anal), which consists of 29 items in four domains: lifestyle, behavior, depression, and embarrassment. On a second visit, patients repeated the Fecal Incontinence Quality of Life Scale. For each domain, an evaluation was made of temporal reliability, internal reliability, the convergent validity with the generic questionnaire of health, and the discriminant validity correlating the domains of Cuestionario de Calidad de Vida de Incontinencia Anal with the severity of fecal incontinence. RESULTS: For cultural adaptation, the answer alternatives for 14 items were modified. A total of 111 patients (94 percent) completed the study adequately. Temporal reliability (test-retest) was good for all domains except for embarrassment, which showed significant differences (P < 0.02). Internal reliability was good/excellent for all domains (Cronbach alpha >0.80, between 0.84 and 0.96). The four domains of Cuestionario de Calidad de Vida de Incontinencia Anal significantly correlated with the domains of the generic questionnaire on health (P < 0.01) and with the scale of severity of fecal incontinence (P < 0.001). All domains of Cuestionario de Calidad de Vida de Incontinencia Anal correlated negatively with the need to wear pads (P < 0.01) and with the presence of complete fecal incontinence. CONCLUSIONS: The Cuestionario de Calidad de Vida de Incontinencia Anal incorporates sufficient requirements of reliability and validity to be applied to patients with fecal incontinence.

Adult↗
PubMed2000

Comparison of patients' and physicians' rating of urinary incontinence following radical prostatectomy.

One of the most important endpoints following a radical prostatectomy focuses on the recovery of urinary continence; however, the reported incontinence rates have been quite variable. In men with prostate cancer, it has been found that the physician's assessment of a patient's symptom does not correlate with the patient's own assessment. To further explore the differences in the reported outcomes between physicians and patients, we evaluated the assessment of urinary incontinence in a cohort of men undergoing radical prostatectomy. A total of 145 individuals completed a brief urinary continence questionnaire postoperatively at the 1-year anniversary of their operation and also had the physicians' assessment of incontinence documented in the medical record. Patient-reported incontinence rates varied from 13% to 65% depending on the definition of incontinence applied and the greatest agreement was seen when the physicians' assessment of incontinence was compared with the patient's report of pad use and urinary bother. These comparisons resulted in only moderate to good levels of agreement, which suggests that a more reliable and accurate means to evaluate urinary incontinence following radical prostatectomy needs to be developed.

Adult↗