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Title: Urge Incontinence May Follow Surgery for Stress Incontinence in Patients with Depression: Presented at AUGS

" Urge Incontinence May Follow Surgery for Stress Incontinence in Patients with Depression: Presented at AUGS"

By Paula Moyer SAN DIEGO, CA -- August 6, 2004 -- Women who are depressed and undergo surgery for stress incontinence are at risk for postoperative urge incontinence, according to findings presented here July 31st at the 2004 American Urogynecologic Society/Society of Gynecologic Surgeons Joint Scientific Meeting. "Urge incontinence isn't uncommon after stress incontinence surgery," reported principal investigator Daniel M. Morgan, MD, chief resident and house officer in obstetrics-gynecology at the University of Michigan in Ann Arbor, Michigan. "We found that severity of postoperative urge incontinence is related to the length of follow-up and the severity of depression. However, our findings do not imply causality between depression and urge incontinence but may show us a potential target for treatment of postoperative urge urinary incontinence." In order to identify factors that could make urge incontinence more likely after surgery for stress incontinence, the researchers reviewed the surgery outcomes for a cohort of 440 women who had undergone surgery for stress incontinence between 1993 and 2003. The surgeries involved included retropubic urethropexy, the pubovaginal sling, and tension-free vaginal tape placement. The patients responded to multiple health-related quality-of-life questionnaires in a cross-sectional study. Of the patients whose charts were drawn, 66% responded. The questionnaires included the Incontinence Symptom Index (ISI), a validated 10-item questionnaire eliciting symptoms of stress and urge incontinence and bother, and the Patient Health Questionnaire (PHQ) a validated instrument screening for depression. Dr. Morgan and his coinvestigators used generalized linear models to evaluate correlations between the severity of urinary incontinence and factors such as socioeconomic status, medical, surgical, gynecologic, and psychiatric histories. The patients were an average of 55 ą 12.5 years old. The median follow-up was 3.2 ą 2.5 years, with a follow-up range of 1 to 10 years. Following surgery, 35% of patients complained that at least once per day they had significant episodes of urge incontinence. The age-adjusted urinary incontinence symptom severity increased with the duration of follow-up (P =.0069). Those with the longest follow up, 6 to 10 years, had the highest symptom scores. The investigators also found that the severity of depression was also found to be linked to increasing urge incontinence (P =.0014). Age was marginally associated with urge incontinence (P =.06), as was a history of irritable bowel syndrome (P =.06). Several following factors had no correlation with urge incontinence. Obstetrical-gynecologic factors that were unrelated included a history of vaginal delivery, caesarean section, hysterectomy, the use of hormone replacement therapy, and the number of incontinence operations. Other unrelated factors included cigarette use, alcohol use, race, body mass index, and level of education and income. [Presentation title: Factors Correlated With Urge Urinary Incontinence Following Surgery for Stress Incontinence. Abstract 47]

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