Despite its high prevalence, many women delay seeking treatment for stress urinary incontinence (SUI) due to multiple reasons that may be associated with patient socio-demographic characteristics, health-related behaviors, comorbidities, and psycho-social factors.  Living with this condition may have a significant impact on the quality of life. Review and use of data from qualitative studies will add further insights in terms of patient experiences and views on the condition of SUI, as well as treatments. 

The aim of this study was to synthesize and systematically evaluate evidence from qualitative studies on women’s experiences around SUI and its treatments. Integrating qualitative evidence in the process of COS for SUI development may help to ensure that patients' priorities are well represented.

This study was registered with The International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42019141032. A comprehensive search of the published literature was carried out to identify qualitative studies on SUI in women, published in English language. Studies that collected and analysed data using mixed or purely quantitative methods, those that included male participants or investigated other types of pelvic floor disorders were excluded from the analysis. 

The literature search strategy included the following terms: [‘stress urinary incontinence’ and (‘women’ or ‘female’) and (‘qualitative research’ or ‘interview’ or ‘delphi’ or ‘focus group’)] to ensure the inclusion of all relevant records. The literature search was carried out in August 2020. Five relevant databases were interrogated, namely: Medline, Embase, Scopus, PsycInfo and CINAHL. 

The studies included in this meta-synthesis were assessed for conceptual clarity and rigour based on a Critical Appraisal Skills Programme (CASP) tool for qualitative research. Issues such as the coherence of the research goal, the research design, the clarity of the methodology and data collection, the risk of bias, the adherence to ethical standards, data analysis quality, validity of the results and contribution to the existing knowledge required consideration.

Thematic synthesis was chosen for the purpose of this study given that this method is in line with our objective of aggregating existing evidence and identifying patterns within data.

Four hundred ninety studies were initially identified, narrowed to 432 after removing duplicates. Following title screening, 432 studies remained, and their abstracts were read. Of those, 52 papers were assessed for eligibility by reading the full texts and finally, seven studies that evaluated experiences and perceptions of a total of 197 women suffering from SUI met the criteria for inclusion in this synthesis. 

The characteristics of the included studies, the methodologies and tools used for data collection are presented in table 1. 

In terms of quality assessment, two of the included papers met all the CASP criteria and the other five ones had only one unmet CASP criteria, showing minor methodological limitations. All studies provided rich data on SUI related experiences of women.

Six distinct, but interrelated analytic themes emerged from the studies regarding patients' perspectives of SUI: experiencing SUI, awareness of SUI, treatments for SUI, sexuality, communication, and psychosocial effects. Two of the main themes, namely treatments for SUI and experiencing SUI also included related sub-themes such as: choosing treatment, expectations of treatment, investigations prior to treatment, living with SUI and effects on the quality of life.

Promoting patient choice is a priority in the current context and the findings of this study enrich the body of knowledge resulting from quantitative studies by pointing out individual aspects that matter for women with SUI. These should not be overlooked in order to promote better research methodologies and standards, improve patient involvement in clinical decision making, ensure good adherence to treatments, leading to better outcomes.

This study provides insights on how SUI is experienced by women, reflected by the following overarching themes: experiencing SUI, awareness of this condition, treatments, communication, sexuality, and psychosocial effects of SUI. Researchers should integrate findings of qualitative studies in future projects not only to ensure that patient priorities are not overlooked, but also to potentially guide the development of a COS for SUI.