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Pelvic Floor Symptoms Improve Similarly After Pessary and Behavioral Treatment for Stress Incontinence

Kenton, Kimberly MD, MS*; Barber, Matthew MD, MHS; Wang, Lu PhD; Hsu, Yvonne MD§; Rahn, David MD; Whitcomb, Emily MD; Amundsen, Cindy MD#; Bradley, Catherine S. MD, MSCE**; Zyczynski, Halina MD††; Richter, Holly E. PhD, MD‡‡and for the Pelvic Floor Disorders Network

Female Pelvic Medicine & Reconstructive Surgery: March/April 2012 - Volume 18 - Issue 2 - p 118–121
doi: 10.1097/SPV.0b013e31824a021d
Original Articles
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Objective The objective of this study was to determine if differences exist in pelvic symptom distress and impact on women randomized to pessary versus behavioral therapy for treatment of stress urinary incontinence (SUI).

Methods Change in symptom and condition-specific health-related quality-of-life (HRQOL) measures were compared between pessary and behavioral groups 3 months after randomization in the Ambulatory Treatments for Leakage Associated With Stress Incontinence trial. Four hundred forty-six women with symptoms of SUI were randomized to continence pessary, behavioral therapy (pelvic floor muscle training and continence strategies) or combination therapy. Validated measures utilized included urinary, prolapse, and colorectal scales of the Pelvic Floor Distress Inventory; urinary, prolapse, and colorectal scales of the Pelvic Floor Impact Questionnaire; and Stress and Urge scales of the Questionnaire for Urinary Incontinence Diagnosis. Student t test and analysis of variance were used to compare scores within and between groups.

Results Mean age of participants was 49.8 (SD, 11.9) years; 84% were white, and 10% were African American. One hundred forty-nine were randomized to pessary, and 146 to behavioral therapy. Baseline symptoms and HRQOL scores were significantly reduced within treatment arms at 3 months after randomization, but there was no statistically significant difference between groups.

Conclusions There was no difference in pelvic floor symptom bother and HRQOL between the pessary and behavioral therapy arms in women undergoing conservative treatment for SUI. Individualized preference issues should be considered in the approach to the nonsurgical treatment of SUI.

Pelvic floor symptoms improve after both pessary and behavioral treatment for stress incontinence.

From the *Departments of Obstetrics & Gynecology and Urology, Loyola University Chicago, IL; †Obstetrics, Gynecology, & Women’s Health Institute, Cleveland Clinic, Cleveland OH; ‡Data Coordinating Center, University of Michigan, Ann Arbor MI; §Department of Obstetrics & Gynecology, University of Utah Medical Center, Salt Lake City, UT; ∥Department of Obstetrics & Gynecology, University of Texas-Southwestern Medical Center, Dallas, TX; ¶Department of Reproductive Medicine, University of California-San Diego, San Diego, CA; #Department of Obstetrics & Gynecology, Duke University, Durham, NC; **Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA; ††Department of Obstetrics & Gynecology, University of Pittsburgh; and ‡‡Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham AL.

Correspondence: Kimberly Kenton, MD, MS, Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology and Urology, Loyola University Chicago, Stritch School of Medicine, 2160 S First Ave, Maywood, IL 60153. E-mail: kkenton@lumc.edu.

The authors have nothing else to disclose.

This study was supported by grants from the Eunice Kennedy Schriver National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women’s Health (U01 HD41249, U10 HD41250, U10 HD41261, U10 HD41267, U10 HD54136, U10 HD54214, U10 HD54215, and U10 HD54241).

This trial is registered at clinicaltrials.gov (NCT00270998).

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins