**2. Material and methods**

132 Urinary Incontinence

on an uneven surface) can lead to an involuntary release of urine (Dutkiewicz, 2002;

A typical feature of USI should incorporate the general similarity of symptoms in the day to day and the lack of nocturnal enuresis or nocturia. USI is thought to be caused by many different factors. Petros's Integral Theory (Petros, 2005), which is widely accepted, associates functional disturbances of the pelvic floor with structural disorders. The pelvic floor is formed by organs (the bladder with urethra, the vagina and the anus, the fascia and ligaments that bind them, the muscles). To simplify somewhat, the contracting muscles stabilize the organs in relation to the connective tissue elements, so damage to the ligaments and connective tissue can result in the lack of proper closure (manifested by urinary or fecal incontinence) or vaginal dysfunction, and the resulting symptoms and discomfort of which

Due to the considerable prevalence and nature of the symptoms, USI is a major medical and social problem. The intimate nature of the symptoms and their negative impact on daily functioning produces a significant mental burden for both the patients and their partners, and causes the frustration of many psychological, social and existential needs (Wyman et al., 1990; Wyman, 1994; Broome, 2003; Chiaffarino et al., 2003; Møller & Lose, 2005;

The scope of the psychological problems caused by the symptoms of USI is particularly large in advanced stages of the disease (Lagro-Janssen et al., 1992a; 1992b). Lalos et al. (2001) found that the life of persons with urinary incontinence changes dramatically, in respect to

 The nature and style of family life is changed, sexual activity with the partner is changed(see also Norton et al., 1988), and the family budget is burdened with expenses related to treatment and mitigation of symptoms, such as sanitary pads, diaper-panties,

Career plans are changed, vocational activity is limited, and sometimes a career change

 Social functioning is impaired and social contacts are limited (see also Brown et al., 1998; Wein & Rovner, 1999; Anders, 2000; Thom, 2000; Tołłoczko, 2002; Smutek et al.,

 It is estimated that approximately 25% of person suffering from urinary incontinence are on disability pension, where one of the main reasons for a ruling of disability is the significant extent of the incontinence and the impossibility of working because of the disease. This can cause a feeling of low self-esteem, a loss of personal dignity and social position, deterioration of mood, and social isolation, which lowers the health-related

The lack of treatment, or the postponement of treatment until many years after the first symptoms appear, can have a major impact on the appearance of both physical and mental

The problem of evaluating HRQOL in persons with urinary incontinence has been perceived by researchers and clinicians, for whom HRQOL has become in recent years an extremely important indicator of the psychological functioning of patients. An assessment of HRQOL

family life, vocational life, and social life (including the quality of life):

is necessary, or even withdrawal from professional work.

2004; Bidzan et al., 2005a,b; Bidzan, 2008).

quality of life (HRQOL; Norton et al., 1988).

complications (Banach, 2004).

Rechberger & Skorupski, 2005).

the patients complain.

Papanicolaou et al., 2005).

etc.

The initial population (N = 917) consisted entirely of patients treated in the period from 2002 to 2006 in the Pro-Vita Private Medical Center for Urinary Incontinence, in Gdansk, Poland.

All these patients were subjected to a thorough diagnostic process for urinary incontinence, consistent with the standards of the International Continence Society (ICS), as follows:

	- physical examination (focusing on the evaluation of the pelvic floor support);

A Model of the Psychological Factors Conditioning Health

a structured clinical interview (developed by the authors);

**2.1 A preliminary model of the factors conditioning HRQOL** 

directly influence the quality of life and the indirect variables.

patients suffering from urinary incontinence;

satisfaction, emotional expression);

acquired by means of a given instrument.

women patients with UUI

an interview conducted by a psychologist, a psychiatrist, and a neurologist;

conservative management.

Conscientiousness;

contacts).

This group underwent the following:

Related Quality of Life in Urodynamic Stress Incontinence Patients After TVT 135

The study population is 108 patients who underwent TVT for severe SUI refractory to

 the NEO-FFI Personality Inventory (by Costa and McCrae), which is used to assess five basic dimensions of personality: Neurotism, Extroversion, Openness, Agreeability, and

the King's Health Questionnaire (KHQ), used to assess the quality of life of women

 the Dyadic Adjustment Scale (DAS), developed by Spanier, which gives a thorough assessment of the quality of marital relations (general level, agreeability, consistency,

 the Coping Inventory for Stressful Situations (CISS), designed by Endler and Parker, which diagnoses styles of coping with stress conditioned by personality. These include the task-oriented style, the emotion-oriented style, and the avoidance-oriented style (this last style can have two variants: engaging in substitute activities and seeking social

On the basis of previous research (Bidzan, 2008) a model has been developed for the assumed relationships between HRQOL and selected psychological measures (personality traits, quality of relationship, and coping styles). The pathways analysis method was used. In the opinion of many researchers (e.g. Cwalina, 2000; Gaul & Machowski, 2004) this method is distinctly superior to both the ANOVA approach and factor analysis in testing correlational and differential accuracy on the basis of a multi-feature, multi-method matrix. Pathway analysis, unlike other methods, provides not only quantitative indices of weight (the "feature factor" and the "method factor"), but also a model of the structure of the data

The model we are proposing, which is shown in Fig. 1, takes in both the variables that

Fig. 1. Proposed model of relations between selected psychological measures and HRQOL in


The results of the medical examination made it possible to determine for each patient the form (type) of urinary incontinence - USI, UUI, or mixed urinary incontinence (MUI) - along with the degree of symptom intensity.

The study population is 108 patients who underwent TVT for severe SUI refractory to conservative management.

This group underwent the following:

134 Urinary Incontinence

incontinence);

diagnosis);

VCMG/CM

with the degree of symptom intensity.

 self explanatory (in order to exclude urinary tract infections before treating urinary incontinence, since inflammation of the urinary tract can give symptoms of urinary

 a cough test (to objectivize the patient's subjective complaints; the cough test is performed in the supine position immediately after micturition, while the stress cough test is performed in prone or sitting position with full bladder; the release of urine through the urethra during the cough test is considered a positive result for USI; This indicates a low leak point pressure it should be remembered, however, than in from 5% to 10% of cases the patient continues to complain of incontinence despite

a negative result on this test). This should be part of the physical examination. measurement of residual urine volume (the volume of urine remaining in the bladder after micturition should not exceed 10-15% of its capacity, i.e. 50 ml; the measurement is done by ultrasound scan; this evaluation is essential to preclude

 an evaluation of the 72hrs urination journal traditionally called a bladder diary and should be for a total of 72hrs/3 days (in which the patient writes down the number of urinations, the time interval between them, and episodes of involuntary release

 the 24 hour pad weight test (objectively measuring the amount of urine released involuntarily during a standard set of physical exercises performed by the patient e.g. marching, sitting, climbing stairs, by measuring the mass or the electrical

 an evaluation of the mobility of the urethra, called the "Q-tip test" (a test to reveal excessive mobility of the cervix of the urinary bladder and the proximal segment of the urethra, when the change of position of a cotton swab inserted into the urethra

a urodynamic examination (an objective method to confirm the previous

 urethral profilometry (which makes it possible to measure intratubular pressure simultaneously along the entire length of the urethra, along with intravesical pressure); Urethral pressure has now become less of a key issue in incontinence

an electromyogram; Not routinely used but is done in conjunction with the

 ultrasound and CT imaging (in the ultrasound test a high resolution vaginal head is used to observe the dynamics of changes in spatial relations between the cervix of the urinary bladder and the urethra); Ths imaging studies should be inserted after the the physical examination but before the invasive assesments ie CMG. This is not a standard evaluation tool in incontinence and is usually only utilized in the evaluation of suspected anatomical abnormalities or suspected calculus disease or

cystoscopy (Abrams et al., 1988; Abrams et al., 2002; Milart & Gulanowska-Gędek,

The results of the medical examination made it possible to determine for each patient the form (type) of urinary incontinence - USI, UUI, or mixed urinary incontinence (MUI) - along

the possibility of incontinence resulting from overfilling of the bladder;

of urine and traditionally the amount of fluid intake);

during the valsalva maneuver is greater than 30°);

malignancy complicating the presentation

2002; Rechberger & Skorupski, 2005; Waszyński, 2005).

resistance of the sanitary pad before and after the exercises);

and is traditionally completed at the time of a VCMG/CMG

