Association of baseline severity of lower urinary tract symptoms with the success conservative therapy for urinary incontinence in women

Introduction and hypothesis To identify the association between the symptom severity and outcome of conservative management for OAB, SUI and MUI. Conservative treatments are recommended for overactive bladder (OAB), stress urinary incontinence (SUI) and mixed incontinence (MUI). It is unclear whether disease severity affects treatment outcome. Methods Patients receiving conservative management were reviewed. Disease-specific questionnaires (OAB-q SF, ICIQ-UI SF) and bladder diaries recorded baseline symptoms. Success was defined by Patient Global Impression of Improvement questionnaire (PGI-I) response of "very much better" or "much better". Non-parametric statistical tests and logistic regression were used. Results In 50 OAB patients success was associated with lower symptom severity [30 (0-80) vs. 80 (23-100), p=0.0001], fewer urgency episodes [4 (0-12) vs. 6 (0-11), p=0.032] and lower ICIQ-UI SF [5.5 (0-20) vs. 15 (0-21), p=0.002], but higher QoL [67 (20-101) vs. 24 (6-58), p=0.0001]. In 50 MUI patients, variables were fewer urgency episodes [3 (0-10) vs. 6 (0-16), p=0.004] and lower ICIQ-UI [11 (1-18) vs. 15 (5-21), p=0.03]. In 40 SUI patients, variables were fewer incontinence episodes [1 (0-4) vs. 2 (0-5), p=0.05] and lower ICIQ-UI [11 (6-16) vs. 13.5 (11-19), p=0.003]. Multiple regression confirmed OAB-q QoL [odds ratio (OR) 1.10 (95% confidence intervals 1.04, 1.1)] for OAB, urgency episodes [OR 0.74 (0.56, 0.98)] and ICIQ-UI [OR 0.83 (0.71, 0.98] for MUI and ICIQ-UI [OR 0.57 (0.40, 0.83)] for SUI. Conclusions Milder baseline disease severity was associated with successful outcome. There is potential for triage at initial assessment to second-line interventions for women unlikely to achieve success.