Manuel Montesino Semper

Urinary incontinence in women affects 15% of women of adult age, but only one in four requests health assistance and when the disorder is serious. In his PhD thesis, Manuel Montesino Semper, Head of the urology section of the Virgen del Camino Hospital in Pamplona, analysed the financial cost which would be required for surgical operations to be carried out under the Navarre public health service in order to combat the problem. “When costs include the enhancement in the quality of life of the patients” he explained, “one comes to the conclusion that, from a perspective of the economics of health standards, such operations are cost-effective or, stated in another way, they are socially profitable, given that, with relatively low costs, benefits in the quality of life for the patients are obtained”.

Urinary incontinence is the involuntary loss of urine. In the case of adult women it means an important deterioration in their quality of life and a challenge for the urologist and gynaecologist who have to attend to them. According to doctor Montesino, “this problem, at times hidden and even taboo, gives rise to important financial costs for the health services and for the patients themselves, besides the intangible costs involved in the personal insecurity and anxiety that can arise”.

Some types of incontinence, such as those produced on doing physical exercise and associated or not with the urgency to urinate, need treatment using surgery. As a solution nowadays, artificial devices in the form of small meshes are fitted into the ureter (the duct through which the urine exits from the bladder). These devices enhance support in the zone and close the ureter.

The PhD defended at the Public University of Navarre (UPNA), “Analysis of costs of utility and cost effectiveness for surgical treatment for urinary incontinence in women through the fitting of meshes – within the Navarre public health service”, was led by Juan Cabasés Hita, Professor of Applied Economics and Eduardo Sánchez Iriso, from the Department of Economics at the UPNA, and obtained the top grade of cum laude on an unanimous vote.

Effective surgery and enhanced quality of life

The research undertaken by Doctor Montesino Semper showed that surgical operations for urinary incontinence are effective and provide a clear enhancement in the quality of life of the women affected. “In patients who have been operated on, improvements are manifest in aspects involving anxiety and depression, with mobility and undertaking everyday activities, family activities or free time ones, as well as household chores”, pointed out the author of the research.

Apart from the financial cost this type of surgical operation involves, this thesis also evaluated the enhancement in the quality of life of the women undergoing surgery and, finally, the two parameters were linked. “The conclusion is, from the perspective of the economics of health standards, such operations are cost-effective or, stated in another way, they are “socially profitable”, given that, with relatively low costs, benefits in the quality of life for the patients are obtained”.

The costs computed for this PhD thesis included the health care from the first medical check-up carried out after one year after the operation, the sum coming to 1,250 euros per patient. Most operations are outpatient ones, without any need for patients to spend the night in hospital. Moreover, the operation is relatively simple, being carried out with local anaesthetic.

The research analysed the results from 69 patients through a questionnaire, one specific to urinary incontinence and the other about general health, both internationally recognised and validated.

Factors such as being younger and the type of urinary incontinence (associated only with physical effort, without urgency) are associated with better results in surgical operation, while overweight and obesity are associated with results that are not so good.

* Elhuyar translation, published in www.basqueresearch.com