A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)

The aim of this study was to develop the short form of a condition-specific, reliable, validated and self-administered instrument to evaluate sexual function in women with pelvic organ prolapse and/or urinary incontinence. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire –12 (PISQ-12) was developed from the data of 99 of 182 women surveyed to create the long form (PISQ-31). An additional 46 patients were recruited for further validation. All subsets regression analysis identified 12 items likely to predict PISQ-31 scores. Short form scores underwent correlation analysis with long form, Incontinence Impact Questionnaire – 7 (IIQ-7), Sexual History Form –12 (SHF-12) and Symptom Questionnaire (SQ) scores. Test–retest reliability was checked with a subset of 20 patients. All subsets regression analysis with R>0.92 identified 12 items that predicted PISQ-31 scores. Short form scores were highly correlated with long form scores (R=0.75–0.95). Correlations of the PISQ-12 with SHF-12 (R=–0.66 and –0.68) and IIQ-7 (R=–0.38 and –0.54) scores were similar to correlation of the PISQ-31 with these other measures. Reliability was moderate to high, with weighted values from 0.56 to 0.93. PISQ-12 scores were lower in patients with low sexual function as measured on the SHF-12 (P <0.001), and lower in women with depression as measured on the SQ (P <0.001). The PISQ-12 is a validated and reliable short form that evaluates sexual function in women with urinary incontinence and/or pelvic organ prolapse and predicts PISQ-31 scores. It is able to distinguish women with poor sexual function as measured on the SHF-12.Editorial Comment: For decades, clinicians and researchers have described treatment success in our field as resolution of either anatomic defects or of urinary of fecal leakage. We have all had patients with perfect anatomic support after a prolapse operation who were unhappy because of problems with pain, leakage, defecation or sexual function. Yet, considering these and other quality of life issues as part of the definition of treatment success is a recent development. The emphasis on the importance of assessing various quality of life indicators is snow-balling, yet our efforts to do so have been hampered by the absence of good, easy to administrate, reliable and valid tools. The short form of the PISQ is an eagerly awaited tool that fills this void. From a research prospective, information derived from responses to this questionnaire will allow us to understand the effect of various treatments on sexual function, arguably one of the most important and least investigated domains of quality of life. When completed by patients in a clinical setting, the PISQ-12 provides a template for clinicians to discuss sexuality with patients, and to suggest appropriate interventions. In developing the long and short forms of this instrument, the authors have set a high standard for others developing quality of life instruments to strive for.Study supported by NCRR-GCRC Grant # M01 RR00997Presented at American Urogynecologic Society annual meeting in Hilton Head, South Carolina, USA, 2000An erratum to this article can be found at     

The Portuguese validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)

Introduction and hypothesis  

Sexual well-being is an important aspect of women's life. The objective of this study was to validate the Portuguese-translated version of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire—PISQ-12.     

Validation of web-based administration of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12)

Introduction and hypothesis  

We studied a web-based version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).     

Validation of the Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

Introduction and hypothesis

The aim of the study was to develop a Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) to evaluate sexual function in patients with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) versus a control group.

Methods

Before the validation study, a pilot study of the Polish version of the PISQ was performed in 22 women with pelvic floor dysfunctions. The respondents completed the questionnaire at recruitment and 2 weeks later. Test–retest reliability and internal consistency were determined. The validation study was performed in 249 sexually active women (123 with urodynamic SUI and POP; 126 healthy controls). The study group reported urinary incontinence (UI) at the urogynecological ambulatory clinic, where they underwent urogynecological and urodynamic examinations. All participants completed the questionnaire. PISQ results from both groups were compared and correlated with those of the King’s Health Questionnaire (KHQ) and patient age.

Results

Test–retest reliability was good according to Pearson’s correlation coefficient (r?=?0.89, p?<?0.001). PISQ had high internal consistency (Cronbach’s α?=?0.878). The total PISQ score was significantly lower in the study group compared with the controls (83.6?±?14.9 vs 95.7?±?10.3, p?<?0.001), as were scores for individual domains: Behavioral/Emotive, Physical, Partner-Related (33.9?±?10.2 vs 39.8?±?7.8, 31.7?±?6.9 vs 37.1?±?2.8, and 18.0?±?3.1 vs 19.4?±?2.6 respectively; p?<?0.001), confirming the lower quality of sexual function in women with SUI and POP. A correlation between PISQ and KHQ scores and patient age was confirmed.

Conclusions

The Polish version of the PISQ is a reliable tool for evaluating sexual function in women with POP and UI.

     

Hungarian language validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire,IUGA-Revised (PISQ-IR)

Introduction and Hypothesis

Until now, no valid Hungarian questionnaire has existed to evaluate the sexual quality of life of women with pelvic floor disorders. The aim of this study was to translate the Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), into Hungarian and to validate the translated PISQ-IR.

Methods

PISQ-IR was translated and validated using three steps, as guided by the IUGA international protocol: forward translation by two urogynecologists, a community review process consisting of one-on-one cognitive interviews with 20 patients, and backward translation by a native English speaker. The final version was approved by the IUGA Working Group comprising the original authors.

Results

Among sexually active women, good internal consistency was observed for all scales of the adapted instrument: global quality (Cronbach’s α?=?0.75), condition impact (α?=?0.87), desire (α?=?0.82), arousal/orgasm (α?=?0.67), partner-related (α?=?0.61) and condition-specific (α?=?0.67). Among women who were not sexually active, internal consistency was valid for three scales: condition-specific (α?=?0.70), global quality (α?=?0.81) and condition impact (α?=?0.86). Cronbach’s α could not be determined in the partner-related domain because only two items were included. Criterion validity and reliability showed strong significant correlations with the UI at the Clinical-Q values and the FSFI and PFDI-20 tests.

Conclusions

The PISQ-IR Hungarian version is a valid and reliable tool that is equivalent to the original English questionnaire and assesses sexual function in Hungarian women with pelvic organ prolapse, urinary incontinence and/or fecal incontinence.

     

Questionnaire for evaluation of sexual function in women with genital prolapse and/or incontinence. Validation of the Spanish version of "Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)"

This article summarizes the work done to adapt and to validate the short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) for its use in Spain. It will become the first validated questionnaire in this country for the evaluation of the sexual function in women with Pelvic Organ Prolapse and/or Urinary Incontinence. PATIENTS AND METHOD: 49 women who visited a specialized unit with symptoms of pelvic floor were included. Patients filled in the Spanish version of the questionnaire to validate (PISQ-12), the Urinary Incontinence Questionnaire (ICIQ-UI-SF); the Female Sexual Function Questionnaire (FSM) and the Bladder Control Autoevaluation Questionnaire (CACV). Factibility, reliability and validity of the new questionnaire were evaluated. RESULTS: Factibility: 99.83% of the sample answered all the items (only one patient did not answer one of the items); average administration time 3.5 (1.5) minutes. RELIABILITY: Cronbach's alpha was 0,829. Validity: PISQ-12 correlation with FSM was 0,71; with ICIQ-UI-SF it was -0,038; with the CACV "symptoms" dimension the correlation was -0,30 and with the "discomfort" dimension it was -0,40. The existence of the same three dimensions of the PISQ-12 original version in the adapted Spanish questionnaire is checked through a factorial analysis. The score in PISQ-12 was worse (lower) in the case of women with Hyperactive Bladder symptoms and discomfort measured with the CACV questionnaire and in women with sexual dysfunction measured with FSM. PISQ-12 is an instrument with the appropriate psychometric characteristics to evaluate sexual function in women with pelvic floor problems.     

Sexual Function in Women with and without Urinary Incontinence and/or Pelvic Organ Prolapse

The sexual function of women with and without urinary incontinence and/or pelvic organ prolapse (UI/POP) was compared using a condition-specific validated questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ). Eighty-three women with UI/POP and 56 without agreed to participate. PISQ scores were significantly lower among women with UI/POP than in those without (P = 0.003). No differences in the stages of sexual excitement were noted between groups. The frequency of intercourse was less with UI/POP than without (P = 0.04). Women with UI/POP restricted sexual activity for fear of losing urine more frequently than did those without (P= 0.005). No differences were reported in patients’ or partners’ sexual satisfaction. This study found that women with UI/POP have poorer sexual functioning than those without, as measured by the PISQ, and report less frequent sexual activity. In addition, women with UI/POP are more likely to restrict sexual activity for fear of incontinence, although they report similar levels of satisfaction with their sexual relationships as do women without UI/POP.     

A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)

Introduction and hypothesis

The objective of this study was to create a valid, reliable, and responsive sexual function measure in women with pelvic floor disorders (PFDs) for both sexually active (SA) and inactive (NSA) women.

Methods

Expert review identified concept gaps and generated items evaluated with cognitive interviews. Women underwent Pelvic Organ Prolapse Quantification (POPQ) exams and completed the Incontinence Severity Index (ISI), a prolapse question from the Epidemiology of Prolapse and Incontinence Questionnaire (ISI scores), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Female Sexual Function Index (FSFI). Principle components and orthogonal varimax rotation and principle factor analysis with oblique rotation identified item grouping. Cronbach’s alpha measured internal consistency. Factor correlations evaluated criterion validation. Change scores compared to change scores in other measures evaluated responsiveness among women who underwent surgery.

Results

A total of 589 women gave baseline data, 200 returned surveys after treatment, and 147 provided test-retest data. For SA women, 3 subscales each in 2 domains (21 items) and for NSA women 2 subscales in each of 2 domains (12 items) emerged with robust psychometric properties. Cronbach’s alpha ranged from .63 to .91. For SA women, correlations were in the anticipated direction with PFDI-20, ISI, and FSFI scores, POPQ, and EPIQ question #35 (all p?<?.05). PFDI-20, ISI, and FSFI subscale change scores correlated with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire International Urogynecological Association-revised (PISQ-IR) factor change scores and with mean change scores in women who underwent surgery (all p?<?.05). For NSA women, PISQ-IR scores correlated with PFDI-20, ISI scores, and with EPIQ question #35 (all p?<?.05). No items demonstrated differences between test and retest (all p?≥?.05), indicating stability over time.

Conclusions

The PISQ-IR is a valid, reliable, and responsive measure of sexual function.     

The minimum important difference for the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire

Introduction and hypothesis

Although the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire (PISQ) is widely used to assess sexual function in women, the minimum important difference (MID) (defined as the smallest difference in scores of a patient-reported outcome measure that is perceived by patients as beneficial or harmful and which would lead the clinician to consider a change in treatment) is not known. The objective was to estimate the MID for the PISQ.

Methods

Two study populations, one of women with overactive bladder (OAB) and urgency UI (UUI) treated with tolterodine in a placebo-controlled trial (cohort I), and one of women treated surgically for prolapse and/or UI (cohort II) were used. Cohort I anchors were the Overactive Bladder Questionnaire (OAB-q), the Patient Perception of Bladder Condition (PPBC), the Patient Perception of Treatment Benefit Questionnaire (PPTBQ), and the change in number of UUI episodes in bladder diaries. Distribution MIDs were also calculated.

Results

In the anchor-based analysis, the MID values for changes in PISQ total scores at 3 months in cohort I were 5 points using the UUI anchor (diary-dry women), 5 points using the PPBC anchor, 5 points with the PPTBQ, and 9 points with the OAB-q. In cohort II, the MID at week 12 in PISQ total scores was 7 points in women with improved IIQ-7 scores. The distribution-based MID in PISQ total scores was 5.3 points in cohort I and 5.8 points in cohort II.

Conclusion

A reasonable estimate of MID for the PISQ total score is 6 points. Improvements that meet these thresholds may be considered clinically important.     

Incontinence quality of life questionnaire (I-QOL): translation and validation study of the Iranian version

Introduction and hypothesis  Because of the importance and prevalence of incontinence among women, there is increasing interest in the development and use of well-constructed questionnaires studying quality of life. Also, there is a paucity of information on QOL in non-Western women suffering from urinary incontinence. The aim of this study was to translate the original English version of the I-QOL and to assess the reliability and validity of this questionnaire in Iranian patients with urinary incontinence. Methods  Four hundred women with urinary incontinence completed the Persian version of the questionnaire. By Cronbach’s alpha coefficient, the intraclass correlation coefficient, and confirmatory factor analysis, the reliability and validity of the questionnaire were assessed. Results  The median age of the respondents was 48 years (range 27–90). The overall I-QOL summary score showed internal consistency of 0.96 (Cronbach’s alpha). The intraclass correlation coefficient was 0.96 for the total score. The range of correlation between the I-QOL total score and the subscales of the Sf-36 and the Psychological General Well-Being (PGWB) questionnaires were between 0.47 to 0.59 and 0.52 to 0.61 respectively. Conclusion  The Persian version of the I-QOL can be used for measuring QOL in urinary incontinent women in Iran.     

Management of Postoperative Lower Urinary Tract Symptoms (LUTS) After Pelvic Organ Prolapse (POP) Repair

Purpose of Review

Pelvic organ prolapse (POP) is a common condition for which approximately 200,000 US women annually undergo surgical repair [Am J Obstet Gynecol 188:108–115, 2003]. After surgical correction, persistent or new lower urinary tract symptoms (LUTS) can be present. We provide guidance on the current tools to predict, counsel, and subsequently handle postoperative LUTS. The current literature is reviewed regarding LUTS diagnosis and management in the setting of prolapse surgery with an emphasis on newer developments in this area.

Recent Findings

1. 1.
   More severe stages of prolapse are positively correlated with obstructive symptoms [Am J Obstet Gynecol 185:1332–1337, 2001], but not with other LUTS [Adv Urol 2013:5673753, 2013, Eur J Obstet Gynecol Reprod Biol 177:141–145, 2014, Am J Obstet Gynecol 199:683, 2008, Int Urogynecol J 21:1143–1149, 2010].
    
2. 2.
   One-week ambulatory pessary trial is an effective way to approximate postoperative results—one study correctly predicted persistent urgency and frequency in addition to occult stress urinary incontinence in 20% of study population [Obstet Gynecol Int 2012:392027, 2012].
    
3. 3.
   No preoperative overactive bladder (OAB) symptom was the best predictor for the absence of de novo OAB symptoms postoperatively [Int Urogynecol J 21:1143–1149, 2010].
    
4. 4.
   Urge incontinence patients respond favorably to sacral neuromodulation [Neurourol Urodyn 26: 29–35, 2007], botulinum toxin, and anticholinergic therapy [Res Rep Urol 8:113–122, 2016 , N Engl J Med, 367:1803–1813, 2012].
    
5. 5.
   Primary bladder outlet obstruction (BOO) can be treated effectively with alpha antagonists or anticholinergics, timed voiding, and pelvic physiotherapy as first-line therapy.
    

Summary

Counseling regarding postoperative LUTS is key when planning POP surgery. A thorough understanding of patient history is crucial to successful repair. Patients with significant preoperative symptoms, history of neurologic disease, pelvic floor dysfunction, bladder neck obstruction, or higher stages of anterior wall prolapse may be higher risk for postoperative LUTS. UDS with or without reduction and an ambulatory pessary trial can help prognosticate. Patients will likely maintain a positive therapeutic relationship postoperatively for LUTS if counseled preoperatively.

     

手术治疗女性压力性尿失禁及盆底器官脱垂对患者生活质量的影响

目的：研究手术治疗女性压力性尿失禁（SUI）及盆底器官脱垂（POP）对健康相关生活质量的影响。方法：选择自2001年1月~2007年1月接受TVT、经闭孔无张力吊带术（TVT-O）、前路植入网带及整体植入网带的患者共142例．109例人选并同意参加本研究。采用改良PFDI-20量表评估术前3个月、术后6～12个月及术后12个月以后患者生活质量,采用方差分析对不同性功能变化情况的PFDI-20评分进行比较。结果：PFDI-20总分及POP评分术后较术前显著降低（P〈0．0167）,但术后12个月以后与术后6～12个月相比差异元统计学意义（P〉0．0167）。术后6～12个月时肛直肠症状评分较术前降低,但差异无统计学意义（P;0．0169）。术后12个月以后以术前及术后6～12个月相比均显著改善（P〈0．01671。术后6～12个月及术后12个月以后泌尿系症状较术前显著降低（P〈0．0167）,并且12个月以后较术后6～12个月亦显著改善（P=0．003）．61例术前术后均有性生活。术后6～12个月,20例（37．0％〉术后性功能受损,11例（20．4％）改善．23例（42．6％）无变化;术后12个月以后,21例（34．4％）术后性功能受损,12例（19．7％）改善,28例（45．9％）无变化;术后12个月以后性功能与术后6～12个月相比,无进一步变化;未发现生活质量与性功能之间存在关系。105例（96．3％）患者对手术疗效满意。结论：TVT、TVT-O及经阴道网带治疗SUI及POP疗效显著,术后患者生活质量显著提高。