Background
Methods
Study design
Participants and setting
Materials and data collection
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Have a clinical diagnosis of SUI or stress predominant MUI
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Have stated that their family is complete
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Have undergone a course of supervised pelvic floor muscle training (PFMT) (with or without other nonsurgical treatments for their urge symptoms) with inadequate resolution of their symptoms
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Both the woman herself and her treating clinician should agree that surgery is an appropriate and acceptable next line of treatment
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Symptomatic pelvic organ prolapse (POP) requiring treatment
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Previous surgery for urinary incontinence (UI) or POP
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Urodynamic investigation within the last 3 years
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Neurological disease causing UI
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Current involvement in competing research studies, e.g. studies of investigation or treatment of UI
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Unable to give competent informed consent
Analysis
Results
Vignette number | Centre (A–G) and Screener (1–2) | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
A | B | C | D | B | A | E | F | G | C | F | %Yes | Grade breakdown | Majority/definitive grade | |||||
1 | 1 | 1 | 1 | 2 | 2 | 1 | 1 | 1 | 2 | 2 | Y | Y? | N? | N | ||||
8 | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | 100 % | 11 | 0 | 0 | 0 | Y | Y |
14 | Y | Y | Y | Y | Y | Y | Y | Y | Y? | Y | Y | 100 % | 10 | 1 | 0 | 0 | Y | Y |
17 | Y | Y | Y | Y? | Y | Y | Y? | Y | Y | Y | Y | 100 % | 9 | 2 | 0 | 0 | Y | Y |
4 | Y | Y | Y? | Y? | Y? | Y | Y | Y | Y | Y | Y | 100 % | 8 | 3 | 0 | 0 | Y | Y |
7 | Y | Y | Y | Y? | Y | Y? | Y? | Y | Y | Y? | Y? | 100 % | 6 | 5 | 0 | 0 | Y | Y |
1 | Y? | Y | Y? | Y? | Y? | Y | Y? | Y? | Y? | Y | Y | 100 % | 4 | 7 | 0 | 0 | Y? | Y |
3 | Y | Y | Y? | Y | Y | Y | Y | Y | Y | Y? | N? | 91 % | 8 | 2 | 1 | 0 | Y | Y |
20 | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | Y | 91 % | 10 | 0 | 0 | 1 | Y | Y |
6 | Y? | Y? | Y? | Y? | Y? | Y | Y? | Y? | Y? | Y | N? | 91 % | 2 | 8 | 1 | 0 | Y? | Y |
12 | Y? | Y? | Y | Y? | Y? | Y? | N | Y? | Y? | Y? | N | 82 % | 1 | 8 | 0 | 2 | Y? | Y |
16 | Y | Y? | Y | Y? | Y? | N | N? | Y? | Y | N | Y | 73 % | 4 | 4 | 1 | 2 | Y/Y? | Y |
9 | Y? | Y? | Y? | Y? | N? | Y | Y? | N? | N | Y? | Y? | 73 % | 1 | 7 | 2 | 1 | Y? | Y |
2 | Y | Y? | Y? | Y? | Y | Y | N | N | Y | N | N? | 64 % | 4 | 3 | 1 | 3 | Y | Y |
11 | Y? | Y? | N | Y? | Y? | Y | N | Y? | N | N | N | 55 % | 1 | 5 | 0 | 5 | Y?/N | Y |
5 | Y? | N | Y? | Y? | N? | N? | Y | N | N | N | N? | 36 % | 1 | 3 | 3 | 4 | N | N |
18 | N | Y? | N | N | N | N? | Y? | Y? | N | Y? | N | 36 % | 0 | 4 | 1 | 6 | N | N |
19 | N | Y? | N | N? | Y? | Y | Y | N | N | N? | N | 36 % | 2 | 2 | 2 | 5 | N | N |
10 | N? | N | Y? | N? | N? | N | N | N | N | N? | N? | 9 % | 0 | 1 | 5 | 5 | N?/N | N |
13 | Y? | N | N | N? | N? | N? | N | N | N | N | N | 9 % | 0 | 1 | 3 | 7 | N | N |
15 | N | N | N | N | N | N | N | N | N | N | N | 0 % | 0 | 0 | 0 | 11 | N | N |
% Yes (Y or Y?) | 80 % | 80 % | 75 % | 75 % | 70 % | 65 % | 65 % | 65 % | 60 % | 60 % | 45 % | |||||||
‘Yes’ when majority ‘No’ | 2 | 2 | 2 | 1 | 1 | 1 | 3 | 1 | 0 | 1 | 0 | |||||||
‘No’ when majority ‘Yes’ | 0 | 0 | 1 | 0 | 1 | 2 | 4 | 2 | 2 | 3 | 5 | |||||||
Total ‘disagreements’ | 2 | 2 | 3 | 1 | 2 | 3 | 7 | 3 | 2 | 4 | 5 | |||||||
Centre recruitment | 37 | 75 | 20 | 8 | 75 | 37 | 15 | 17 | 50 | 20 | 17 |
Screener B1 (a high recruiting centre) excluded only 2 patients and commented on 5 vignettes with ‘I would send info’ e.g. ‘Even though physio isn’t mentioned, I would send info’ (patient 2); ‘Since no specific comment that woman requesting treatment for prolapse, I would send info’ (patient 3); ‘Although sounds urge-predominant, I would send info’ (patient 6); and ‘not enough in GP letter to exclude, so I would send info’ (patient 9). |
Screener G1 (a high recruiting centre) excluded only 2 patients and commented on 7 vignettes with ‘I would try to contact patient prior to sending info’, e.g. ‘I would try to contact patient prior to sending info to check predominant symptom’ (patient 1); ‘I would try to contact patient prior to sending info to ensure no OAB symptoms’ (patient 2); ‘I would try to contact patient prior to sending info to check prolapse not significant’ (patient 7); and ‘I would try to contact patient prior to sending info to check has had physio’ (patient 12). |
Screener F2 (a low recruiting centre) excluded 11 women (5 of whom were included by the majority), on the grounds of missing information, e.g. ‘Need to check notes and if documented that patient has stress incontinence and received PFMT then would be eligible but if it is only on patient’s say so then further investigations would be beneficial to give a diagnosis’ (patient 3); ‘Would need to clarify what conservative measures patient had tried, if PFMT then would be eligible if family complete’ (patient 6); ‘No mention of PFMT and type of incontinence would need establishing and high possibility given age of having more children’ (patient 11). |
Screener C2 (a low recruiting centre) excluded 8 women (3 of whom were included by the majority), e.g. ‘History suggests at least some OAB and has had urodynamics before’ (patient 16). |
Screener E1 (a low recruiting centre) excluded 7 women (4 of whom were included by the majority), e.g. they excluded one who reported ‘a dragging sensation’, but with no examination findings provided, on the grounds of ‘Patient has symptoms of prolapse’ (patient 12). |
Screener G1 (a high recruiting centre) excluded only 2 women, both of whom were included by the majority, commenting ‘Would need urodynamics to determine the main symptom’ (patients 9 and 16). |