IIMPACT: Incontinence & Intimate Partners: Assessing the Contribution of Treatment

Sponsor
Loyola University (Other)
Overall Status
Completed
CT.gov ID
NCT01559389
Collaborator
Astellas Pharma US, Inc. (Industry)
138
1
2
63.7
2.2

Study Details

Study Description

Brief Summary

Urge urinary incontinence (UUI) is a socially debilitating disease due to its inherently unpredictable nature and sometimes large volumes of urine loss. Women with UUI may experience anxiety over public episodes of incontinence and concerns about odor and, as a result, isolate themselves socially. This isolation affects both partners in the relationship and may be a source of discord. The impact of UUI also moves into personal relationships where fears or actual episodes of incontinence during physical intimacy, including but limited to intercourse, may result in limited interactions and changes in the relationship satisfaction for both partners. Few studies have examined the role of urinary incontinence, particularly UUI, in the dynamics of an intimate partner relationship and none have evaluated the impact of successful UUI treatment.

The long-term goal of our research is to understand the social and emotional impact of pelvic floor disorders, particularly UUI, on the well-being of an intimate relationship. Ultimately, we aim to evaluate the role that successful treatment plays in the alleviation of discord in intimate partner relationships that are affected by UUI and other pelvic floor disorders.

Our objective for this proposal is to characterize, using validated, quantifiable methods the quality of the relationship in couples affected by UUI and to identify the role that treatment plays in improving this relationship. Our central hypothesis is that UUI has a negative impact upon the emotional and physical well-being of a relationship and that effective treatment will result in improvement in areas of the relationship that have been detrimentally affected by UUI. Our rationale for this study is that an understanding of UUI in the context of a couple, particularly from the perspective of the male partner, will improve our ability to holistically treat UUI, thus improving patient outcomes and satisfaction.

Condition or Disease Intervention/Treatment Phase
Phase 4

Detailed Description

Chronic illness places emotional, physical, and financial burdens upon both the patient and her partner and can be a significant source of stress in a relationship. The symptoms of UUI inherently pose greater social challenges than those faced by women other forms of pelvic floor disorders. For example, women with UUI may avoid social situations due to fear of having an accident or may be reluctant to participate in activities during which it may be difficult to find a bathroom. The resulting social isolation impacts both members of the dyad and may serve as a source of relationship discord. Changes in sexual function and perceived intimacy, including non-intercourse intimacy, as well as communication may be new sources of stress in a previously healthy relationship or may serve to amplify pre-existing relationship problems.

Sexual function is another area in which UUI may cause a negative impact. Studies of coital incontinence among incontinent clinic populations report prevalence ranging from 10%-56% with a median of 22%. The prevalence of coital incontinence may be related to the type of incontinence as well as the severity of symptoms. Stress incontinence has been associated with leakage of urine during intercourse, while detrusor instability and urge incontinence have been correlated with leakage during orgasm. A cross-sectional study of women with UUI and urinary incontinence found that among women reporting low sexual desire, stress incontinence was common (47%), while 46% of women reporting orgasmic phase dysfunction reported symptoms of urge incontinence. Qualitative data corroborates the negative impact of UUI on dyadic and sexual relations.

Another mechanism by which UUI may affect satisfaction with dyadic relations is through depressive symptomatology. Urinary incontinence is associated with a decrease in overall health-related quality of life and is positively correlated with depression, anxiety, and stress. Studies of other chronic illnesses demonstrate a correlation between the patient's level of depression and that of their spouse; level of depression shows an inverse relationship with degree of satisfaction with the relationship.

One of the two studies in the published literature that use quantitative methods to evaluate the impact of urodynamic stress incontinence and detrusor overactivity on the marital relationship concluded that both sexual function and marital relationships are negatively affected by incontinence. This study, like others, is based upon the perspective of the female partner. A recent study of Swedish women with urinary incontinence and urgency is the only study which includes the perspective of the male partner to examine the impact of UUI on the relationship. It concludes that, "Female urinary incontinence, urgency and frequency significantly impair the quality of life in both younger and older women, and also have negative effects on the partner relationship and the partner's life".

The perspective of intimate partners of women with UUI and other forms of PFD is largely missing from the literature. Any analysis of the role of UUI in intimate partner relationships is incomplete without this perspective.

Study Design

Study Type:
Interventional
Actual Enrollment :
138 participants
Allocation:
Non-Randomized
Intervention Model:
Single Group Assignment
Intervention Model Description:
Women presenting with UUI symptoms will receive up to 16 weeks of solifenacin.Women presenting with UUI symptoms will receive up to 16 weeks of solifenacin.
Masking:
None (Open Label)
Primary Purpose:
Supportive Care
Official Title:
Incontinence & Intimate Partners: Assessing the Contribution of Treatment
Actual Study Start Date :
Mar 9, 2012
Actual Primary Completion Date :
Jun 29, 2017
Actual Study Completion Date :
Jun 29, 2017

Arms and Interventions

Arm Intervention/Treatment
Experimental: Female Partners

This arm comprises female partners who receive up to 16 weeks of solifenacin treatment for their UUI symptoms

Drug: Solifenacin
Women presenting with UUI symptoms receive 5 to 10 milligrams (mg) of daily solifenacin for up to 16 weeks
Other Names:
  • Vesicare
  • No Intervention: Male Partners

    This arm comprises healthy male partners

    Outcome Measures

    Primary Outcome Measures

    1. Baseline Sexual Satisfaction Between Matched Female and Male Partners [0 Weeks]

      Prior to beginning treatment with solifenacin, females presenting with UUI complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Their male partners also complete the GRISS at the baseline visit. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.

    Secondary Outcome Measures

    1. Change in Overall Sexual Satisfaction Among Females [Baseline and 12-16 weeks]

      Females presenting with UUI complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS) at baseline (0 weeks) and after 12-16 weeks of treatment with solifenacin. For this outcome, the baseline score is subtracted from the follow-up score and this change score is compared between those who respond and do not respond to treatment with solifenacin. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.

    2. Change in Overall Sexual Satisfaction Among Healthy Male Partners [Baseline and 12-16 weeks]

      Healthy male partners of female participants complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS) survey. For this outcome, their baseline score is subtracted from their follow-up score which is collected after their female partner completes approximately 12-16 weeks of solifenacin treatment for UUI symptoms. This change score is compared between male partners of female participants who respond to solifenacin versus male partners of female participants who do not respond to solifenacin. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    Yes

    Healthy male partners may volunteer to participate in this study along with their affected female partners. There are no inclusion or exclusion criteria for male partners.

    For affected female participants, the following inclusion criteria apply:
    • Age ≥ 18 years

    • In a relationship with a male partner for at least 3 months

    • Not pregnant or planning to become pregnant

    • Have a diagnosis of UUI or Mixed Urinary Incontinence (MUI) that is urge predominant based on a 3 day voiding diary

    • Are interested in medical management of their symptoms

    • Are candidates for solifenacin

    • Are able to provide informed consent

    • Are able to complete written questionnaires.

    For affected female partners, the following exclusion criteria apply:
    • Post Voided Residual (PVR) > 200 ml at the initial visit

    • History of a significant outflow obstruction

    • History of persistent/recurrent Urinary Tract Infection (UTI)

    • History of bladder stones

    • History of a diagnosis of chronic interstitial cystitis

    • History of pelvic irradiation

    • Current pelvic malignancy

    • Narrow angle glaucoma

    • Urinary or gastric retention

    • Current use of a tricyclic antidepressant

    • A neurologic diagnosis that could affect bladder function

    • History of chronic pelvic pain

    • Active psychotic disorder

    • Male partner does not speak English

    • Declines permission for the study team to recruit their male partner for the study

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Loyola University Medical Center Maywood Illinois United States 60153

    Sponsors and Collaborators

    • Loyola University
    • Astellas Pharma US, Inc.

    Investigators

    • Principal Investigator: Elizabeth Meuller, MD, Loyola University

    Study Documents (Full-Text)

    More Information

    Publications

    Responsible Party:
    Elizabeth Mueller, Associate Professor, Loyola University
    ClinicalTrials.gov Identifier:
    NCT01559389
    Other Study ID Numbers:
    • 203952
    First Posted:
    Mar 21, 2012
    Last Update Posted:
    Dec 2, 2019
    Last Verified:
    Nov 1, 2019
    Individual Participant Data (IPD) Sharing Statement:
    No
    Plan to Share IPD:
    No
    Studies a U.S. FDA-regulated Drug Product:
    Yes
    Studies a U.S. FDA-regulated Device Product:
    No
    Product Manufactured in and Exported from the U.S.:
    No
    Keywords provided by Elizabeth Mueller, Associate Professor, Loyola University
    Additional relevant MeSH terms:

    Study Results

    Participant Flow

    Recruitment Details Patients were recruited from March 2012 through July 2016 (52 months) from the Division of Female Pelvic Medicine & Reconstructive Surgery at Loyola University Medical Center.
    Pre-assignment Detail
    Arm/Group Title Females With UUI Male Partners
    Arm/Group Description This arm comprises female partners who receive up to 16 weeks of solifenacin treatment for their UUI symptoms This arm comprises the healthy male partners of the female participants
    Period Title: Overall Study
    STARTED 69 69
    COMPLETED 49 49
    NOT COMPLETED 20 20

    Baseline Characteristics

    Arm/Group Title Females With UUI Male Partners Total
    Arm/Group Description This arm comprises females who receive up to 16 weeks of solifenacin treatment for their UUI symptoms This arm comprises the healthy male partners of the female participants Total of all reporting groups
    Overall Participants 49 49 98
    Age (Count of Participants)
    <=18 years
    0
    0%
    0
    0%
    0
    0%
    Between 18 and 65 years
    49
    100%
    49
    100%
    98
    100%
    >=65 years
    0
    0%
    0
    0%
    0
    0%
    Sex: Female, Male (Count of Participants)
    Female
    49
    100%
    0
    0%
    49
    50%
    Male
    0
    0%
    49
    100%
    49
    50%
    Race/Ethnicity, Customized (Count of Participants)
    White
    37
    75.5%
    36
    73.5%
    73
    74.5%
    Black
    8
    16.3%
    8
    16.3%
    16
    16.3%
    Asian
    0
    0%
    1
    2%
    1
    1%
    Hispanic
    4
    8.2%
    3
    6.1%
    7
    7.1%
    Other
    0
    0%
    1
    2%
    1
    1%
    Region of Enrollment (participants) [Number]
    United States
    49
    100%
    49
    100%
    98
    100%
    Marital Status (Count of Participants)
    Married
    42
    85.7%
    42
    85.7%
    84
    85.7%
    Divorced
    3
    6.1%
    1
    2%
    4
    4.1%
    Single
    4
    8.2%
    6
    12.2%
    10
    10.2%
    Education (Count of Participants)
    High school or less
    19
    38.8%
    0
    0%
    19
    19.4%
    At least some college
    29
    59.2%
    0
    0%
    29
    29.6%
    Not reported
    1
    2%
    0
    0%
    1
    1%
    Years with Partner (Count of Participants)
    Fewer than 30 years
    24
    49%
    23
    46.9%
    47
    48%
    30 or more years
    25
    51%
    26
    53.1%
    51
    52%
    Body Mass Index (Count of Participants)
    Less than 30 kg/m^2
    19
    38.8%
    19
    38.8%
    30 kg/m^2 or more
    30
    61.2%
    30
    61.2%
    Menstrual Cycle (Count of Participants)
    Pre-menopausal
    9
    18.4%
    0
    0%
    9
    9.2%
    Post-menopausal
    38
    77.6%
    0
    0%
    38
    38.8%
    Not certain
    2
    4.1%
    0
    0%
    2
    2%
    Vaginal Parity (Count of Participants)
    0-1 births
    8
    16.3%
    0
    0%
    8
    8.2%
    2 births
    20
    40.8%
    0
    0%
    20
    20.4%
    3 births
    10
    20.4%
    0
    0%
    10
    10.2%
    4-6 births
    11
    22.4%
    0
    0%
    11
    11.2%
    Prior Surgery (Count of Participants)
    Yes
    27
    55.1%
    27
    55.1%
    No
    22
    44.9%
    22
    44.9%
    Prior Treatments for Overactive Bladder Syndrome (Count of Participants)
    Yes
    19
    38.8%
    19
    38.8%
    No
    30
    61.2%
    30
    61.2%
    Prior Treatment for Pelvic Floor Disorders (Count of Participants)
    Yes
    20
    40.8%
    20
    40.8%
    No
    29
    59.2%
    29
    59.2%
    General Health (Count of Participants)
    Excellent
    4
    8.2%
    8
    16.3%
    12
    12.2%
    Very Good
    10
    20.4%
    16
    32.7%
    26
    26.5%
    Good
    25
    51%
    16
    32.7%
    41
    41.8%
    Fair
    8
    16.3%
    8
    16.3%
    16
    16.3%
    Poor
    2
    4.1%
    1
    2%
    3
    3.1%
    Medical History (Count of Participants)
    Hypertension
    0
    0%
    16
    32.7%
    16
    16.3%
    Erectile dysfunction
    0
    0%
    13
    26.5%
    13
    13.3%
    Arthritis
    0
    0%
    13
    26.5%
    13
    13.3%
    Diabetes
    0
    0%
    9
    18.4%
    9
    9.2%
    Cancer
    0
    0%
    9
    18.4%
    9
    9.2%
    Heart disease
    0
    0%
    6
    12.2%
    6
    6.1%
    Depression
    0
    0%
    6
    12.2%
    6
    6.1%
    Currently Sexually Active (Count of Participants)
    Yes
    36
    73.5%
    36
    73.5%
    No
    13
    26.5%
    13
    26.5%

    Outcome Measures

    1. Primary Outcome
    Title Baseline Sexual Satisfaction Between Matched Female and Male Partners
    Description Prior to beginning treatment with solifenacin, females presenting with UUI complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Their male partners also complete the GRISS at the baseline visit. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.
    Time Frame 0 Weeks

    Outcome Measure Data

    Analysis Population Description
    [Not Specified]
    Arm/Group Title Females With UUI Male Partners
    Arm/Group Description This arm comprises female partners who receive up to 16 weeks of solifenacin treatment for their UUI symptoms This arm comprises the healthy male partners of the female participants
    Measure Participants 49 49
    Mean (Standard Deviation) [score on a scale]
    4.2
    (2.3)
    4.8
    (2.4)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Females With UUI, Male Partners
    Comments The null hypothesis is that there is no difference in the overall GRISS score between females with UUI and their male partners
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value .16
    Comments P-values less than 0.05 were considered statistically significant.
    Method t-test, 2 sided
    Comments The method was a paired t-test
    Method of Estimation Estimation Parameter Mean Difference (Final Values)
    Estimated Value -0.51
    Confidence Interval (2-Sided) 95%
    -1.23 to 0.21
    Parameter Dispersion Type: Standard Deviation
    Value: 2.50
    Estimation Comments
    2. Secondary Outcome
    Title Change in Overall Sexual Satisfaction Among Females
    Description Females presenting with UUI complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS) at baseline (0 weeks) and after 12-16 weeks of treatment with solifenacin. For this outcome, the baseline score is subtracted from the follow-up score and this change score is compared between those who respond and do not respond to treatment with solifenacin. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.
    Time Frame Baseline and 12-16 weeks

    Outcome Measure Data

    Analysis Population Description
    The analysis population comprises 49 female participants who received up to 16 weeks of solifenacin for the treatment of UUI symptoms
    Arm/Group Title Responder Non-Responder
    Arm/Group Description This arm comprises female participants who respond to solifenacin treatment for their UUI symptoms. Response to treatment comprises those who rate their Global Impression of Improvement (GII) as "a little better", "much better", or "very much better" This arm comprises female participants who do not respond to solifenacin treatment for their UUI symptoms. Non-response to treatment is defined as those who rate their Global Impression of Improvement (GII) as "no change", "a little worse", "much worse", and "very much worse".
    Measure Participants 14 35
    Median (Inter-Quartile Range) [score on a scale]
    -0.5
    0
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Females With UUI, Male Partners
    Comments The null hypothesis is that there is no difference in the overall GRISS change score between those who respond and do not respond to treatment with solifenacin.
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value .003
    Comments
    Method Wilcoxon (Mann-Whitney)
    Comments Exact test
    Method of Estimation Estimation Parameter z-score
    Estimated Value 2.97
    Confidence Interval (2-Sided) %
    to
    Parameter Dispersion Type:
    Value:
    Estimation Comments The z-score is a standardized Wilcoxon statistic. In this study, z-scores with an absolute value exceeding 1.96 indicate a significant difference in the GRISS change score between responders and non-responders of solifenacin treatment
    3. Secondary Outcome
    Title Change in Overall Sexual Satisfaction Among Healthy Male Partners
    Description Healthy male partners of female participants complete the Golombok Rust Inventory of Sexual Satisfaction (GRISS) survey. For this outcome, their baseline score is subtracted from their follow-up score which is collected after their female partner completes approximately 12-16 weeks of solifenacin treatment for UUI symptoms. This change score is compared between male partners of female participants who respond to solifenacin versus male partners of female participants who do not respond to solifenacin. The GRISS is a 28-item self-administered questionnaire that assess the quality of the sexual relationship of a heterosexual couple. Scores range from 0 to 10 with higher scores indicating greater sexual dysfunction.
    Time Frame Baseline and 12-16 weeks

    Outcome Measure Data

    Analysis Population Description
    The analysis population comprises the 49 male partners of the female participants who received up to 16 weeks of solifenacin for the treatment of UUI symptoms
    Arm/Group Title Male Partners of Female Responders Male Partners of Female Non-Responders
    Arm/Group Description This arm comprises the male partners of female participants who respond to solifenacin treatment for their UUI symptoms This arm comprises the male partners of female participants who do not respond to solifenacin treatment for their UUI symptoms
    Measure Participants 14 35
    Median (Inter-Quartile Range) [score on a scale]
    0
    0
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Females With UUI, Male Partners
    Comments The null hypothesis is that there is no difference in the overall GRISS change score between male partners of female participants who respond to solifenacin and male partners of female participants who do not respond to solifenacin
    Type of Statistical Test Superiority
    Comments
    Statistical Test of Hypothesis p-Value .37
    Comments
    Method Wilcoxon (Mann-Whitney)
    Comments
    Method of Estimation Estimation Parameter z-score
    Estimated Value 0.89
    Confidence Interval (2-Sided) %
    to
    Parameter Dispersion Type:
    Value:
    Estimation Comments The z-score is a standardized Wilcoxon statistic. In this study, z-scores with an absolute value exceeding 1.96 indicate a significant difference in the GRISS change score between the two groups

    Adverse Events

    Time Frame Adverse event data were collected for each female participant from March 2012 to June 2017 (i.e., 64 months)
    Adverse Event Reporting Description Male partners were not prescribed solifenacin and, consequently, were not at risk for adverse events. All-Cause Mortality, Serious, and Other (Not Including Serious) Adverse Events were not monitored/assessed for Male Partners.
    Arm/Group Title Females With UUI Male Partners
    Arm/Group Description This arm comprises female partners who receive up to 16 weeks of solifenacin treatment for their UUI symptoms This arm comprises the healthy male partners of the female participants. They were not prescribed solifenacin and, consequently, were not at risk for adverse events
    All Cause Mortality
    Females With UUI Male Partners
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 0/49 (0%) 0/0 (NaN)
    Serious Adverse Events
    Females With UUI Male Partners
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 0/49 (0%) 0/0 (NaN)
    Other (Not Including Serious) Adverse Events
    Females With UUI Male Partners
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 0/49 (0%) 0/0 (NaN)

    Limitations/Caveats

    There are no limitations or caveats to report

    More Information

    Certain Agreements

    All Principal Investigators ARE employed by the organization sponsoring the study.

    There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

    Results Point of Contact

    Name/Title Elizabeth Mueller, MD
    Organization Loyola University Medical Center
    Phone 708-216-2180
    Email emuelle@lumc.edu
    Responsible Party:
    Elizabeth Mueller, Associate Professor, Loyola University
    ClinicalTrials.gov Identifier:
    NCT01559389
    Other Study ID Numbers:
    • 203952
    First Posted:
    Mar 21, 2012
    Last Update Posted:
    Dec 2, 2019
    Last Verified:
    Nov 1, 2019