**4. Discussion**

In the model we developed for this group of women who had undergone TVT there is one indirect sequence of influences affecting HRQOL: Neurotism (-) - CISS task style (-) - HRQOL; that is, a lower level of Neurotism leads to the choice of the task-oriented style, and the less preference for this style, the higher the evaluation of HRQOL.

According to the assumptions of McCrea and Costa (2005), Neurotism is a personality dimension that reflects the level of emotional adaptation: the higher the score, the greater the susceptibility to experiencing such negative emotions as fear, anger, guilt, the higher the sensitivity to psychological stress, and by the same token the harder it is to cope with a difficult situation, which can have an impact on the subjective lowering of HRQOL. The impact of negative emotions on the possibility of adaptation has been confirmed in many studies.

The indirect influence that our model shows Neurotism exerting on HRQOL is consistent with the findings of other researchers (cf. Ferrie et al., 1984; Norton et al., 1990), who have reported that those women with USI function better who are characterized by a lower level of Neurotism, and with research results indicating that USI patients with low Neurotism scores show better outcomes after surgical treatment (Berglund et al., 1997). It is reasonable to assume that improved psychological functioning has a positive effect on HRQOL.

The model also shows a relationship between HRQOL and the task-oriented coping style, which may result from the possibility of overcoming the symptoms, which are much less in subjective evaluation after TVT. At the same time, the model shows a relationship between less frequent use of the task-oriented style and a higher level of HRQOL. It may seem that this dependence should be rather the reverse, since, in the opinion of many researchers (Janssen et al., 2001) coping with the symptoms of urinary incontinence requires a task-oriented approach.

In the literature the most effective methods of coping with the symptoms of urinary incontinence are thought to include a restriction in the intake of fluids, very regular urination, making toilet maps (e.g. on the road from work to home), using single-use sanitary pads and napkins, and keeping a log of urination (Kinn & Zaar, 1998; Fitzerald et al., 2001; Janssen et al., 2001). These techniques correspond, interestingly enough, with both a task-oriented approach and an avoidance approach (all forms of restriction, such as avoiding fluids), though this is seldom stated directly. This may be at least a partial explanation of the dependency we found. It should also be emphasized that many researchers (e.g. Czapiński, 1994; Bidzan et al., 2004b) emphasize the advantages gained from combining styles of coping with the problem, e.g. task-oriented with emotion, since in this case the patient begins to take some action: to undergo treatment, to comply with physician's orders, to search for their own ways of coping with the problem (using also support networks), or finally to decide on surgery. In other words, they cope more effectively with the disease (cf. Shaw, 2001), which can have a favorable impact on their evaluation of HRQOL. The task-oriented approach alone, though it seems more efficient, is not optimal, and when it is the only strategy used, it can lower HRQOL.
