Ján Švihra, Róbert Dušenka, Ján Ľupták, Igor Sopilko, Viera Švihrová
Objective: Stress urinary incontinence (SUI) is one of the most common dysfunctions of the lower urinary tract, and affects
patients’ quality of life. The principle of quality-adjusted life years (QALYs) was developed by the World Health Organization
(WHO) and the World Bank to enable reasonable health care. QALYs are calculated as the sum of the highest
quality of life years gained as a result of medical intervention. The aims of this study were to compare QALYs after
absorbent products, duloxetine and transobturator tape used in a group of women with SUI.
Materials and Methods: Women were included in the prospective study based on the following inclusion criteria: age higher
than 18 years, SUI, not using absorbent products or duloxetine and surgical treatment of SUI. Exclusion criteria were
urgency or neurogenic urinary incontinence, lower urinary tract cancer and urogenital fistulas. Women were evaluated after
three consecutive six-month periods. In the first period (PAD), incontinence absorbent products were used. In the second
period (Dx), a full titration oral dose (80 mg per day) of duloxetine was used. The third period (TOT) occurred after the
transobturator midurethral sling was implanted. The measurement included the International Consultation on Incontinence
Questionnaire-Urinary Incontinence Short Form (ICIQ-UI), on which, the total score ranges from 0 (without SUI) to
21 (the most severe SUI). The calculation of the weighting factor (WF) was obtained by linear transformation of the ICIQUI
total score as follows: 1 – ICIQ-UI total score/21. The QALYs was calculated as the WF x period of intervention.
Results: The study included 125 women, of whom, 102 were analysed (81.6%). All patients were Caucasian, with a mean
age of 53 years (range 26–69 years). In the PAD, mean ICIQ-UI score decreased from 18.3 to 14. 4. In the Dx, the average
score decreased from 16.9 to 11. 5. In the TOT, the mean score decreased from 17.2 to 1. 7. The WF changes after
the PAD was 0.2 ± 0.1, after the Dx, was 0.3 ± 0.2, and after the TOT was 0.7 ± 0. 1. The mean number of QALYs achieved
after the PAD was 0.16 ± 0.12, after the Dx, was 0.25 ± 0.13 and after the TOT was 0.46 ± 0.05 relative SUI. The changes
were statistically significant (p < 0.01).
Conclusions: All methods increased the number of QALYs. Incontinence absorbent products improved the quality of life
but not the degree of SUI, duloxetine improved the quality of life and decreased the level of SUI, and the transobturator
midurethral sling improved the quality of life and eliminated SUI.