Rufus Cartwright

Experiences and expectations of women with urogenital prolapse: a quantitative and qualitative exploration.

Objectiveu2002 To explore the expectations and goals of women undergoing surgery for urogenital prolapse using both a quantitative quality of life approach exploring symptom bother and a qualitative interview‐based approach exploring patient goals and expectations.

Validity and reliability of the patient’s perception of intensity of urgency scale in overactive bladder

Study Type – Prognosis (outcomes research) u2028Level of Evidenceu20032c

Patient-selected goals in overactive bladder: a placebo controlled randomized double-blind trial of transdermal oxybutynin for the treatment of urgency and urge incontinence

Study Type – Therapy (RCT)u2028Level of Evidenceu20031b

Quality control in urodynamics: Analysis of an international multi‐center study

To review the quality of urodynamic traces collected as part of a multi‐center Phase II drug trial of a medication for overactive bladder (OAB), in order to assess adherence to the Good Urodynamic Practice (GUP) guidelines. To assess inter‐rater reliability (IRR) for the numerical cystometrogram variables, and for the diagnosis of detrusor overactivity (DO).

Prevalence of incontinence and incontinence-specific quality of life impairment in women with cystic fibrosis†‡

Cystic fibrosis (CF) is the commonest autosomal recessive disorder in Caucasians. With advancing medical technology, the life expectancy has more than double in the last twenty years. This has led to new unforeseen health problems like urinary incontinence. The aim was to establish the prevalence, symptomatic typology, and quality of life impact of incontinence in a population of women with CF.

Usage of International Continence Society standardized terminology: A bibliometric and questionnaire study.

We aimed to assess the impact of the 2002 International Continence Society (ICS) standardization report on usage of lower urinary tract terminology in research publications, and compare published usage with awareness of standardized terminology among practicing clinicians.

Validity and reliability of patient selected goals as an outcome measure in overactive bladder

Introduction and hypothesisThe purpose of this study is to assess the validity of patient goal achievement in overactive bladder (OAB).MethodsData were taken from a placebo-controlled randomised trial of transdermal oxybutynin and open label extension study. Face validity was assessed using qualitative analysis. Convergent validity was assessed by comparison with objective symptom improvement. Responsiveness was assessed at 4xa0s, using the standardised effect size. Reliability was assessed between 4 and 12xa0weeks of treatment.ResultsNinety-six women were randomised. There were moderate correlations (0.50–0.51) between goal achievement and symptom improvement for urinary urgency and urge incontinence. Mean goal achievement demonstrated good reliability (intraclass correlationu2009=u20090.82) but low responsiveness (ru2009=u20090.14) between transdermal oxybutynin and placebo-treated groups.ConclusionsAlthough patient goals have good face validity and can be reliably measured, they have limited convergence with conventional measures of OAB severity and improvement and low responsiveness.

Predicting detrusor overactivity using a physician-based scoring system

Women with lower urinary tract symptoms (LUTS) commonly present to primary care. Management is often based on a symptomatic diagnosis alone although LUTS correlate with urodynamic diagnosis in 65% of cases. The aim of this study was to develop a scoring system to discriminate between the symptoms of stress urinary incontinence (SUI) and overactive bladder (OAB). Physicians completed a specially developed questionnaire for all women complaining of LUTS. Women then underwent videocystourethrography. A scoring system based on the likelihood of each symptom for DO was developed using odds ratios and 95% confidence intervals (CI). This scoring system was subsequently used to discriminate those women with OAB from those with SUI. One hundred seventy one women were recruited to the study. This scoring system had a sensitivity of 79%, a specificity of 78% and a positive predictive value of 73% to identify detrusor overactivity (DO) This new OAB scoring system may be used in primary care to help discriminate between USI and DO.

Do women with overactive bladder have realistic expectations for therapy

Introduction and hypothesisThis study aims to determine what women with overactive bladder (OAB) perceive as ‘cure’, assesses treatment acceptability and adverse events. It also determines impact on quality of life (QoL) and correlates it with expectations from therapy.MethodsIn 153 women with predominant OAB symptoms, QoL and expectations regarding ‘cure’ were assessed using KHQ and a novel questionnaire. Analyses were performed using Pearson’s correlation and ANOVA.ResultsConservative measures and lifestyle modifications were acceptable whilst urge incontinence, coital incontinence, constant pad and medication usage were unpopular. Overall, 65% expected to stop leaking altogether once treated. Older women were less prepared to accept side effects such as constipation (pu2009=u20090.03) and dry mouth (pu2009=u20090.012). ANOVA showed significant difference between mean QoL scores for women with different expectations of cure (pu2009=u20090.049).ConclusionsMajority of women have realistic expectations regarding treatment and are willing to tolerate minor symptoms. Regular antimuscarinics remain unpopular and may explain low persistence.

New pharmacological interventions for overactive bladder

This review article assesses the currently available data on new drugs used on and off license for overactive bladder, highlighting the range of pharmacological options. The drugs being considered are solifenacin, darifenacin, transdermal oxybutynin, modified-release propiverine, intravesical botulinum toxin, duloxetine and desmopressin. Although these agents encompass several different modes of action, there is still little evidence to help decide which agent might suit which patient. Furthermore, there have been limited head-to-head studies comparing the efficacy and tolerability of newer drugs. The article concludes with a speculative 5-year view of future developments in the pharmacology of overactive bladder.