The focus ofthis project is to evaluate the feasibility and effectiveness of an out-patient, minimally invasive surgery to American Indian women from a rural reservation community in the Northern Plains who are suffering from stress urinary inconfinence. This study is unique because it is the first research study in which epidemiological discovery will be followed by outpatient treatment for urinary incontinence in this population. There is little data on urinary inconfinence with American Indian women, although they are faced with several of the risk factors for urinary inconfinence, including high rates of parity, diabetes, and smoking (1,2). American Indian women who completed the Urinary Distress Inventory will be followed-up for possible treatment, which ulfimately depends on the type, severity, and underlying cause of urinary incontinence. Participants with moderate to severe stress incontinence will receive outpatient surgical intervenfions at Sanford Health in Sioux Falls, South Dakota. The surgery that will be used for this project is a procedure called the tension-free vaginal tape secure system (TVT System), a procedure that can be performed under local anesthesia and is completed in about 30 minutes. Patients will be followed-up at 1, 3, and 12 months after the inifial procedure. A retrospecfive chart abstraction will be completed to compare this group of American Indian women receiving the TVT procedure with other populations of women. While many other interventions for incontinence are focused on inpatient surgical interventions for stress urinary incontinence, an outpatient, office-based procedure from urogynecological specialists is essential for a rural and minority population of women. Ideally, this research will be the first step in designing larger, long-term clinical trials for American Indian women in the Northern Plains who are affected by urinary incontinence yet are not receiving the care they need. The greatest goal of the study is to evaluate an outpatient intervention with a group of rural, minority women with an overlooked but serious problem.

Public Health Relevance

An outpatient, office-based procedure for urinary inconfinence is essenfial for a rural and minority population of women because of the lack of specialty care in American Indian communifies, the difficulties transporting pafients for care in such rural areas, and the lack of funding for many surgical procedures. The focus of the project is to not only treat women with stress urinary incontinence but also evaluate a model of care that can be sustained long-term.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Exploratory Grants (P20)
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Special Emphasis Panel (ZMD1-PA)
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University of South Dakota
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