Increasingly questionnaires are being used to assess symptoms and impact of quality of life in women with lower urinary tract symptoms (LUTS). The Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire has been developed and shown to be psychometrically valid and reliable and has been objectively validated against perineal pad testing (1). The aim of this study is to evaluate the responsiveness of the BFLUTS questionnaire to change after therapeutic intervention. The therapeutic intervention must be of proven efficacy, therefore the instrument is being tested before and after the current “gold standard” operation for urodynamically proven genuine stress incontinence, the Burch colposuspension.

Methods

Consecutive women, attending for urodynamic investigations, who were found to have a diagnosis of genuine stress incontinence completed the BFLUTS questionnaire. All women, who then subsequently underwent a Burch colposuspension, were posted the BFLUTS questionnaire 3-24 months postoperatively. Burch colposuspension may be expected to decrease urinary leakage, improve stress incontinence symptoms and improve quality of life. These items are analysed here. Bladder filling, voiding and sexual symptoms are also considered.

Wilcoxon signed-ranks tests for paired data were used to determine whether baseline and follow-up questionnaire items differed significantly. The Bonferroni correction was used to adjust for multiple significance testing.

Results

50 women completed both pre and post operative questionnaires. Age ranged between 30 and 71 years, with a mean of 51 years. Patients were followed for a median of 9 months after baseline.

Statistical analysis is based on the 5 response ordinal variables as in the questionnaire. Significant improvements are seen between baseline and follow-up for all of the items concerning urinary leakage and also symptoms relating to frequency and urgency, (p<0.001 for all). A similar picture is seen for the problems caused by these symptoms. Significant differences were also seen in terms of the effect of urinary symptoms on quality of life, for example interference with daily activities (p<0.001). For the purposes of presentation here, the responses in the table below have been dichotomised.

Table: Incontinence and quality of life items from the BFLUTS questionnaire prior to and following Burch colposuspension.

Item	Baseline %	Follow-up %	p-value#
Urinary leakage once per day or more	84	20	<0.0001
Urinary leakage when physically active	100	66	<0.0001
Urinary leakage more than a dribble	88	22	<0.0001
The need to change outer clothing during the day because of urine leakage	89	11	<0.0001
Urinary symptoms affect ability to perform daily tasks (e.g. cleaning, lifting objects)	72	24	<0.0001
Avoid places & situations where a toilet is not nearby	66	51	0.0004
Urinary symptoms interfere with physical activity	94	27	<0.0001

^#Wilcoxon signed-ranks for matched pairs carried out on the full 5 response ordinal variables

Conclusion:

This study shows that items relating to incontinence in the BFLUTS questionnaire are sensitive to change after a Burch colposuspension and further more quality of life items also showed significant improvement. This provides further evidence that the BFLUTS questionnaire is a useful research and clinical tool and can be used to evaluate treatment outcome.

References

1.       Br J Urol 1996; 77: 805-812.