years. Mean follow-up duration was 1.8 years, and ranged from 0.98 to 3.01 years. Of 194 goals listed byparticipants, 40.2% had to do with resuming previous activities or lifestyle, 38.1% with symptom relief, 9.3%with improving self-image and social relationships, 7.7% with improving general health, and 4.6% withimproving physical appearance. At the individual goal level, 72% of goals were attained at short-term, and68% attained at long-term follow-up. Long-term goal achievement did not vary significantly by category ofgoal. Goal achievement was lower only for symptom relief at long-term follow-up (68.9%) than at short-termfollow-up (87.4%, P �.001). At the person level, 45.8% of women reported achieving all listed goals in theshort term, and 42.0% in the long term. Long-term goal achievement was associated with PFD-specificquality of life (UDI-6 and IIQ-7 scores) and inversely associated with surgical complications, but was notassociated with other clinical or demographic variables, including weight, parity, PFD diagnosis, psychiatriccomorbidity, surgical route, or previous surgical history.Conclusion: Self-reported achievement of preoperatively recorded goals for PFD surgery persisted 1 to 3

years after surgery. The association of goal achievement to IIQ-7 and UDI-6 scores suggests that goalachievement is related to, but not identical to, overall measures of PFD life impact and symptom distress.Future work should examine the association of goal achievement to IIQ-7 and UDI-6 scores suggests thatgoal achievement is related to, but not identical to, overall measures of PFD life impact and symptomdistress. Future work should examine the association of goal achievement to clinical measures of PFDseverity, and compare surgically and medically managed patients. Preoperative assessment of goals may bea useful addition to clinical and subjective data in the long-term management of women with pelvic floordisorders.

Editorial Comment: The approach described in these articles is receiving a lot of attentionthese days: that is evaluate results based on goal achievement rather than other subjective oreven objective measures. I think that this approach lends a valuable dimension to the overallassessment of surgical (and other) results. My only problem with this is that it could be, in someor many instances, a self-fulfilling prophecy: that is the patients’ expectations can be changed oradjusted depending on what you, the surgeon or other treating physician, tell them “up front.”

Alan J. Wein, M.D.

The Prevalence of Urinary Incontinence in Community-Dwelling Married Women: A Matter ofDefinition

V. VANDONINCK, B. L. H. BEMELMANS, C. MAZZETTA, C. ROBERTSON, M. KEECH, P. BOYLE AND L. A. KIEMENEY ON

BEHALF OF THE UREPIK STUDY GROUP, Departments of Urology and Epidemiology, University MedicalCenter, Nijmegen, The Netherlands, Division of Epidemiology and Biostatistics, European Institute ofOncology, Milan, Italy, and Global Health Outcomes, GlaxoSmithKline, Greenford, Middlesex, UnitedKingdom

BJU Int, 94: 1291–1295, 2004

OBJECTIVE To determine the prevalence of female urinary incontinence (UI) and its impact on qualityof life.SUBJECTS ANDMETHODS In a Dutch national postal questionnaire survey, 1460 spouses of 1771 men

in the town of Boxmeer, age-stratified and randomly selected, were asked to participate. The prevalence ofUI in the women was assessed in two ways. First, a total score on a short UI-specific questionnairedifferentiated them into three groups, i.e. no symptoms (score 0–2), minimally (3–6) or severely incontinent(7–14). Second, a self-reported UI prevalence was calculated by asking respondents if they ever had urineloss. To conform to the International Continence Society standard definition, spouses were also asked tocomplete a general (Short Form-12) and lower urinary tract disease-specific quality-of-life questionnaire,and were asked about their need to seek help.RESULTS The questionnaires were returned by 1071 women (mean age 57 years, range 29–79; response

rate 73%); 34% were regarded as minimally and 12% as severely incontinent. The self-reported UI rate was40%. Disease-specific and general quality of life was significantly lower for women with UI than for thosewith minimal or no urine loss; 38% of incontinent respondents had consulted a physician for their UI, andamong respondents with minimal complaints this was 28%.CONCLUSIONS Up to 46% of the married female population had some degree of UI, and severe UI

significantly compromised their quality of life.

VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY 217