Urinary incontinence is a serious social problem. The precise number of patients affected by this condition is unknown, which results from the facts that various definitions of this disorder have been adopted and classification systems are not uniform. As the latest data show, urinary incontinence affects as many as 17–60% of the female population, making it one of the most common chronic diseases (Minassian et al., 2003). Estimates suggest that the number of patients is even larger, but that patients do not report their complaints due to embarrassment and a common belief that incontinence is a natural phenomenon associated with aging. The average incidence of this condition is 27.6% for women, and 10.5% for men (Meyer, 2017). The most frequent type is stress incontinence, which constitutes as many as 50% of all incontinence cases among women (Moroni et al., 2016).
Urinary incontinence is defined as involuntary leakage of urine through the urethra due to dysfunction of the closure mechanism of the bladder. In stress incontinence, this is typically induced by a sudden increase in the intra-abdominal pressure (IAP) (Syan, Brucker, 2016). Other symptoms include enuresis (i.e., urination without the urge), a lack of change in the frequency of micturition compared with the period preceding the disease, and the subsiding of symptoms during sleep. The etiopathogenesis of this condition has been attributed to factors disturbing the transfer of intra-abdominal pressure to the junction between the urethra and the bladder, and to the proximal urethra (Kołodyńska et al., 2019).
Factors contributing to urinary incontinence include (Burkhard et al., 2017):
disturbed innervation of the pelvic floor
disturbed structure of connective tissue
chronic pulmonary diseases.
The latest reports indicate that latent urinary incontinence is also extremely common. This is estimated to affect 36–80% of patients with pelvic floor prolapse (Szafranowska, Rogowski, 2018) it is associated with urethral flexion or pressure, potentially leading to micturition disorders. These cause closure of the urethral lumen, and consequently the lack of immediate compression of the bladder, which can trigger urine leakage through the urethra. The symptoms of urinary incontinence in this group of patients thus only occur after surgical reconstruction of the pelvic floor. Currently, reports describing simultaneous surgery for pelvic organ prolapse and urinary incontinence suggest contradictory results. Performing these two procedures at the same time entails a higher number of complications (Khullar et al., 2017). There is no consensus on management of this group of patients. It is, however, certain that the scope of the operation should be decided on with a patient after an interview and physical examination, and after she has been informed of all therapeutic options. Improving the quality of the patient’s life should be given priority (Svenningsen et al., 2012).
A definition of quality of life was proposed by the World Health Organization in 1994; it states that QoL is the individual perception of one’s own position in life with regard to cultural conditions and the system of values. Factors that have an immediate effect on QoL include somatic health, interpersonal contact, and the community features that are essential for a particular person (Kukielczak, 2012). It is significant that physicians do not currently focus exclusively on extending patients’ lives but, also on improving the quality of life. Modern medicine aspires to retrieve patients’ QoL from before the disease. Hence, there is increasing interest in the assessment of the QoL of people affected by various diseases (Jankowska-Polańska, Polański 2014).
At present, not only strictly medical goals, but also nonmedical goals, constitute crucial elements of the therapeutic process; these latter include improving patients’ well-being and functioning in the physical and social spheres. QoL research is part of a holistic approach (Socha et al., 2011). In medicine, both subjective and objective types of QoL assessment should be performed. Subjective assessment of QoL can be based on questions addressed to patients. Nevertheless, this assessment depends on patients’ mental state, likes and dislikes, system of values, personality traits, and so on. Objective QoL assessment, on the other hand, is usually performed using standardized questionnaires. These are valuable, repeatable instruments that measure patients’ QoL and the effectiveness of treatment (Dudzińska et al., 2011).
The aim of this study was to assess QoL in patients with stress incontinence before and after stress incontinence surgery using the TOT method.