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BACKGROUND: Outcomes for surgical management of urinary incontinence are often measured with the use of questionnaires. The urogenital distress inventory (UDI-6) is a composite of various symptom domains. The significance in symptom change is often difficult to interpret. We correlate the changes in the UDI-6 scores with urologist reported patient postoperative satisfaction and improvement in a cohort of patients undergoing distal urethral polypropylene sling (DUPS) for urinary incontinence.
METHODS: An IRB approved retrospective review of a cohort of 275 women undergoing DUPS for urinary incontinence between October 2008 and January 2011. Self-reported preoperative and postoperative questionnaires (UDI-6) were available for review. We assessed urologist reported satisfaction and improvement by performing chart reviews. We looked specifically at UDI-6 items 1 - 4. Categorical variables from Urologist office assessment at one year follow up were dichotomized to “not improved” (0) or “improved” (1) on the areas of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). UDI-6 questionnaires were given to patients before clinical visits. Answers were categorized as No/Not at all/Slightly “improved” (1) and answers Moderately/Greatly as “not improved” (0). Pearson's correlation coefficient was used to correlate urologist outcome assessment of symptoms with UDI-6 items #1 (frequency), #2 (urgency incontinence), #3 (SUI) and #4 (small leak). A coefficient of 1 suggests a very strong correlation.
RESULTS: Data was available for 209/275 patients who underwent DUPS for a diagnosis of either mixed urinary incontinence (MUI) (157) or pure SUI (52). Mean age was 57 years (23-87). Table 1 shows specific correlation for MUI and SUI patients, as well as UDI-6 and urologist's assessment at one year. Urologist's clinical evaluation correlates strongly with UDI-6 item #3 in patients with pure SUI. However our data indicates that this correlation is only moderate when assessing patients with MUI.
CONCLUSIONS: We conclude that a urologist's assessment of surgical outcomes in patients with urinary incontinence correlates strongly with UDI-6 questionnaire data at one year especially when assessing SUI symptoms. However, MUI patients outcomes may be better assessed with the use of validated tools like the UDI-6 questionnaire. We postulate that irritative voiding symptoms maybe the confounder when evaluating surgical outcomes of patients with MUI undergoing DUPS.

Table 1. UDI-6 (items1-4) and Urologist improvement assessment correlation

		#1 Frequency	#2 UUI	#3 SUI	#4 Leak
MUI	UDI-6 (Not at all/ Slightly)	88%	85%	89%	89%
	Urologist (improved)	81%	81%	93%	93%
	r =	0.6	0.71	0.61	0.55
SUI	UDI-6 (Not at all/ Slightly)	100%	100%	88%	94%
	Urologist (improved)	-	-	93%	92%
	r =	-	-	0.8	0.5