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S22-19
(P)
HOW MUCH, NOT HOW OFTEN: PREDICTORS OF BOTHER WITH URINARY
INCONTINENCE AND ITS IMPACT ON QUALITY OF LIFE IN OVER 500 ADULTS
WITH SPINA BIFIDA.
Konrad SZYMANSKI, Rosalia MISSERI, Benjamin WHITTAM, Martin KAEFER, Richard RINK and Mark CAIN
Riley Hospital for Children, Pediatric Urology, Indianapolis, USA
PURPOSE
The effect of urinary incontinence (UI) on health-related quality of life (HRQOL) in adults with Spina Bifida (SB) is poorly
understood. We aimed to determine which quantification method best captures bother with daytime UI, and to quantify
the impact of UI on HRQOL.
MATERIAL AND METHODS
We surveyed an international sample of adults with SB (January 2013-September 2014). We evaluated daytime dry
intervals (≥4h: social continence), quantity of UI (“a lot”, “medium”, “a little”, none) and number of undergarments
worn daily (pads/pull-ups/disposable underwear). Bother was assessed on a 5-point Likert scale. We employed
validated instruments: QUALAS-A (SB-specific HRQOL) and generic WHOQOL-BREF. We analyzed data using linear
regression (all outcome ranges: 0-100).
RESULTS
Mean age of 518 participants was 32 years (33.0% male). Overall, 25.9% were dry for <4h, 50.4% for ≥4h, 23.7%
were always dry. On multivariate analysis, worse bother was predominantly determined by quantity of UI (“a lot:”
+35.1, “medium:” +17.0 vs. “little,” p<0.0001), rather than dry intervals <4h (+8.1, p=0.04) or number of
undergarments (-8.0 to -0.1, p≥0.11). Looking at QUALAS-A scores, we observed lower Bladder and Bowel HRQOL with
higher quantities of UI (“a lot:” -30.5, “medium:” -21.4, “little:” -15.0 vs. none, p<0.0001), but not for dry intervals
<4h (-4.9, p=0.06). Use of undergarments, regardless of number, was associated with lower HRQOL (-10.0 to -12.8,
p≤0.0003). Quantity of UI was the main independent predictor of lower WHOQOL-BREF scores.
CONCLUSIONS
We demonstrate that adults with SB and UI have lower HRQOL than those who are dry. Self-reported quantity of UI
was the best predictor of bother and HRQOL.