***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Pelvic floor electrical stimulation ( PFES ) has been shown to be effective for stress incontinence . However , its role in a multicomponent behavioral training program has not been defined . OBJECTIVE To determine if PFES increases efficacy of behavioral training for community-dwelling women with stress incontinence . DESIGN AND SETTING Prospect i ve r and omized controlled trial conducted from October 1 , 1995 , through May 1 , 2001 , at a university-based outpatient continence clinic in the United States . PATIENTS Volunteer sample of 200 ambulatory , nondemented , community-dwelling women aged 40 to 78 years with stress or mixed incontinence with stress as the predominant pattern ; stratified by race , type of incontinence ( stress only vs mixed ) , and severity ( frequency of episodes ) . INTERVENTIONS Patients were r and omly assigned to 8 weeks ( 4 visits ) of behavioral training , 8 weeks ( 4 visits ) of the behavioral training plus home PFES , or 8 weeks of self-administered behavioral treatment using a self-help booklet ( control condition ) . MAIN OUTCOME MEASURES Primary outcome was percentage reduction in the number of incontinent episodes as documented in bladder diaries . Secondary outcomes were patient satisfaction and changes in quality of life . RESULTS Intention-to-treat analysis showed that incontinence was reduced a mean of 68.6 % with behavioral training , 71.9 % with behavioral training plus PFES , and 52.5 % with the self-help booklet ( P = .005 ) . In comparison with the self-help booklet , behavioral training ( P = .02 ) and behavioral training plus PFES ( P = .002 ) were significantly more effective , but they were not significantly different from each other ( P = .60 ) . The PFES group had significantly better patient self-perception of outcome ( P<.001 ) and satisfaction with progress ( P = .02 ) . Significant improvements were seen across all 3 groups on the Incontinence Impact Question naire but with no between-group differences . CONCLUSIONS Treatment with PFES did not increase effectiveness of a comprehensive behavioral program for women with stress incontinence . A self-help booklet reduced incontinence and improved quality of life but not as much as the clinic-based programs Abstract : The aim of the study was to evaluate the efficacy , safety and effect on quality of life of the Reliance urinary control insert ( Uromed Corp. , Needham , MA ) in women with genuine stress incontinence .  Efficacy was evaluated at baseline and at the end of the 12-month study period by st and ardized pad-weight studies and by rating scales measuring acceptability , incontinence symptom improvement , ease of learning , comfort and time to habituation , recorded in diaries at monthly intervals in 63 women . The SF-36 Health Survey question naire was used to assess quality of life status at baseline without the device and after 12 months of device use . A significant decrease in urine loss at 12 months compared with baseline was shown by st and ardized pad-weight studies , with and without the device in situ . Urine loss was reduced by more than 80 % in 91 % of the 63 patients , and 79 % were completely dry . Patient diaries showed significant improvement in control of leakage , comfort , and ease of device use during the study period . Short-term-36 Health Status data also indicated significant improvement in the physical functioning score at 12 months . Urinary tract infection and hematuria were the most common adverse effects . The Reliance urinary control insert is an efficacious and safe means of controlling genuine stress incontinence in women . The device was perceived as easy to use and comfortable for these 63 women , and result ed in improved quality of life AIMS Symptoms of urogenital dysfunction are known to negatively affect health-related quality of life in women . To assess effectiveness of treatment , it is currently recommended to include measurements of quality of life in outcome analysis . One of the question naires that is commonly used is the combination of the Urogenital Distress Inventory ( UDI ) and Incontinence Impact Question naire ( IIQ ) . Unfortunately , the validity of the UDI and IIQ has only been tested in highly selected subgroups of female patients . Therefore , it is unclear whether this question naire is suitable for use in population s with different characteristics . METHODS We analyzed the scale construction and validity of the UDI and IIQ in a r and om sample of 2,042 women , aged 20 - 70 years old and a clinical sample of 196 women . RESULTS Our results show that the UDI can be divided into five subscales , namely discomfort/pain , urinary incontinence , overactive bladder , genital prolapse , and obstructive micturition . The internal consistency ( Cronbach 's alpha ) ranged between 0.74 and 0.82 . In addition to the original four subscales of the IIQ ( mobility , physical , social , and emotional functioning ) , we identified a fifth subscale with four items about embarrassment . Internal consistency of these subscales ranged between 0.83 and 0.93 . In addition to the internal consistency , we tested the criterion and construct validity of these new subscale division . CONCLUSIONS We found these subscales to be reliable and of clinical use . It is recommended to use the revised UDI and IIQ in outcome analysis of treatments for urogenital symptoms in women OBJECTIVE The purpose of this study was to prospect ively and r and omly compare tension-free vaginal tape ( TVT ) with transobturator suburethral tape ( T.O.T. ) for the surgical treatment of stress urinary incontinence ( SUI ) in women . STUDY DESIGN Sixty-one women with SUI were r and omly assigned to either TVT ( n=31 ) or T.O.T. ( n=30 ) . The preoperative evaluation included a quality -of-life question naire and a comprehensive urodynamic examination . The 1-year outcome included a detrusor pressure-uroflow study to compare bladder outlet obstruction . RESULTS Patient characteristics , preoperative quality of life , and urodynamic evaluation were similar in the 2 groups . Mean operative time was significantly shorter in the T.O.T. group ( 15 min+/-4 vs 27 min+/-8 , P<.001 ) . No bladder injury occurred in the T.O.T. group versus 9.7 % ( n=3 ) in the TVT group ( P>.05 ) . The rate of postoperative urinary retention was 25.8 % ( n=8 ) in the TVT group versus 13.3 % ( n=4 ) in the T.O.T. group ( P>.05 ) . The rates of cure ( 83.9 % vs 90 % ) , improvement ( 9.7 % vs 3.3 % ) , and failure ( 6.5 % vs 6.7 % ) were similar for the TVT and T.O.T. groups , respectively . The 1-year outcome data were collected in 29 women of the TVT group and 27 women of the T.O.T. group . No vaginal erosion occurred in either of the groups . In terms of bladder outlet obstruction , no differences were found after TVT and T.O.T. CONCLUSION T.O.T. appears to be equally efficient as TVT for surgical treatment of stress urinary incontinence in women , with no reduction of bladder outlet obstruction at 1-year follow-up The efficacy of bladder training was evaluated in a r and omized clinical trial involving 123 noninstitutionalized women 55 years and older with urinary incontinence . Subjects were urodynamically categorized as those with urethral sphincteric incompetence ( N = 88 ) and those with detrusor instability with or without concomitant sphincteric incompetence ( N = 35 ) . Bladder training reduced the number of incontinent episodes by 57 % ; the effect was similar for both urodynamic diagnostic groups . The quantity of fluid loss was reduced by 54 % . This was greater for patients with detrusor instability than for those without it . Diurnal and nocturnal voluntary micturitions were also reduced . The effect on nocturnal micturition , however , was not observed in subjects with unstable detrusor function . It is recommended that bladder training be considered as an initial step in treatment of women with urinary incontinence . Provided prior comprehensive clinical evaluation is done , it can be prescribed without the need for urodynamic characterization PURPOSE Sling procedures have been used successfully to treat stress urinary incontinence ( SUI ) . We report our initial experience with the use of a synthetic polypropylene mesh for treatment of SUI . Based on similar surgical principles of cadaveric fascia sling , we describe placement of a thinly woven polypropylene mesh under the distal urethra . We describe our technique and report our initial results . MATERIAL S AND METHODS There were 146 consecutive patients evaluated . All patients had clinical evidence of SUI . Patients underwent preoperative evaluation with video urodynamics , symptom question naire , and cystoscopy . Postoperatively the patients were evaluated at 3-month intervals by symptom question naire , physical examination , and postvoid residuals ( PVR ) . One year after the procedure , all patients were asked to fill out a voiding dysfunction and incontinence symptom question naire and a vali date d quality -of-life question naire . A flow and PVR also were obtained . RESULTS Average intraoperative time was 27 minutes for the sling procedure . There were no intraoperative complications and one major postoperative complication . There was no permanent retention and no erosions . Ninety-two percent of patients had either no or rare stress incontinence . Postoperatively , 7 % of patients developed de novo urge incontinence . CONCLUSION We describe excellent results with a new simple , quick , and inexpensive method to correct SUI by placing a polypropylene mesh under the distal urethra Abstract : Short-form question naires were used to measure the change in quality of life ( QOL ) of women with urge-predominant urinary incontinence treated with imipramine hydrochloride .  Short forms of the Incontinence Impact Question naire ( IIQ-7 ) and the Urogenital Distress Index ( UDI-6 ) were integrated into a patient question naire , which was given to 25 patients with urge-predominant urinary incontinence before and after treatment with imipramine .  Demographic data and self-reports of the number of incontinent episodes were also recorded . Total and subscale QOL scores and number of incontinent episodes were recorded and compared with Wilcoxson ’s signed ranks test , as well as correlated to the change in number of incontinent episodes with Pearson ’s correlation coefficient . Treatment with imipramine result ed in a clinical improvement or cure in 16/22 patients ( 72.7 % ) , with an average reduction in incontinent episodes of 78.7 % ( P<0.001 ) . The average per cent improvement in QOL scores for total IIQ-7 was 42.1 % ( P<0.01 ) and total UDI-6 score was 44.1 % ( P<0.001 ) . All subscale QOL differences were also significant ( P<0.01 ) . The incidence of side effects to imipramine was 41 % , which result ed in dose changes . Fourteen per cent eventually discontinued therapy . Neither total nor subscale QOL improvement scores were correlated with improvement in number of incontinent episodes . The short form IIQ-7 and UDI-6 are effective tools to determine change in QOL , as evidence d by the effectiveness of imipramine for the treatment of urge-predominant urinary incontinence . Significant reductions in incontinent episodes and improvements in IIQ-7 and UDI-6 QOL scores were both seen , but were not correlated . Short-form QOL measures can easily be integrated into a patient question naire to objective ly measure a very subjective topic We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle ( PFM ) exercise and the functional electrical stimulation (FES)-biofeedback treatment , both of which are being widely used as conservative treatment methods for female urinary incontinence . We r and omly selected 60 female incontinence patients who visited our department and divided them evenly into two groups . They were treated for a period of 6 weeks . The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the question naire by Jackson . Objective changes of pelvic muscle contraction force were measured using a perineometer . Pre- and post-treatment maximal pelvic floor muscle contractile ( PMC ) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences ( p<0.001 ) . In particular the FES-biofeedback group showed significantly increased maximal PMC pressure and a decreased severity of urinary incontinence and discomfort compared to the intensive PFM exercise group ( p<0.001 ) . In conclusion , FES-biofeedback proved more effective than simple PFM exercise PURPOSE We determine the efficacy and user acceptability of the urethral occlusive device ( FemAssist ) for incontinence for 1 month and identify factors that may predict successful use of the device . MATERIAL S AND METHODS Baseline and posttreatment outcome measures included a 1-hour pad test , frequency volume chart ( leakage , voiding and number of pads per 24 hour ) , visual analog scale for incontinence impact and quality of life ( Urogenital Distress Inventory ) . The last 36 consecutive women also completed a linear analog scale about attitudes toward touching the genitalia . RESULTS The device was offered to 100 consecutive incontinent women of whom 3 did not enroll in the study and 57 ( 57 % ) completed the 
    Output:
    
The eight QOL measures identified had good clinical face validity and measurement properties .